[House Hearing, 117 Congress]
[From the U.S. Government Publishing Office]


                 NO TIME TO LOSE: SOLUTIONS TO INCREASE 
                  COVID-19 VACCINATIONS IN THE STATES

=======================================================================

                            VIRTUAL HEARING

                               BEFORE THE

              SUBCOMMITTEE ON OVERSIGHT AND INVESTIGATIONS

                                 OF THE

                    COMMITTEE ON ENERGY AND COMMERCE
                        HOUSE OF REPRESENTATIVES

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                            FEBRUARY 2, 2021

                               __________

                            Serial No. 117-1
                            
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]                            


     Published for the use of the Committee on Energy and Commerce

                   govinfo.gov/committee/house-energy
                        energycommerce.house.gov
                        
                                __________

                    U.S. GOVERNMENT PUBLISHING OFFICE                    
45-006 PDF                 WASHINGTON : 2022                     
          
-----------------------------------------------------------------------------------                         
                        
                        
                    COMMITTEE ON ENERGY AND COMMERCE

                     FRANK PALLONE, Jr., New Jersey
                                 Chairman
BOBBY L. RUSH, Illinois              CATHY McMORRIS RODGERS, Washington
ANNA G. ESHOO, California              Ranking Member
DIANA DeGETTE, Colorado              FRED UPTON, Michigan
MIKE DOYLE, Pennsylvania             MICHAEL C. BURGESS, Texas
JAN SCHAKOWSKY, Illinois             STEVE SCALISE, Louisiana
G. K. BUTTERFIELD, North Carolina    ROBERT E. LATTA, Ohio
DORIS O. MATSUI, California          BRETT GUTHRIE, Kentucky
KATHY CASTOR, Florida                DAVID B. McKINLEY, West Virginia
JOHN P. SARBANES, Maryland           ADAM KINZINGER, Illinois
JERRY McNERNEY, California           H. MORGAN GRIFFITH, Virginia
PETER WELCH, Vermont                 GUS M. BILIRAKIS, Florida
PAUL TONKO, New York                 BILL JOHNSON, Ohio
YVETTE D. CLARKE, New York           BILLY LONG, Missouri
KURT SCHRADER, Oregon                LARRY BUCSHON, Indiana
TONY CARDENAS, California            MARKWAYNE MULLIN, Oklahoma
RAUL RUIZ, California                RICHARD HUDSON, North Carolina
SCOTT H. PETERS, California          TIM WALBERG, Michigan
DEBBIE DINGELL, Michigan             EARL L. ``BUDDY'' CARTER, Georgia
MARC A. VEASEY, Texas                JEFF DUNCAN, South Carolina
ANN M. KUSTER, New Hampshire         GARY J. PALMER, Alabama
ROBIN L. KELLY, Illinois, Vice       NEAL P. DUNN, Florida
    Chair                            JOHN R. CURTIS, Utah
NANETTE DIAZ BARRAGAN, California    DEBBBIE LESKO, Arizona
A. DONALD McEACHIN, Virginia         GREG PENCE, Indiana
LISA BLUNT ROCHESTER, Delaware       DAN CRENSHAW, Texas
DARREN SOTO, Florida                 JOHN JOYCE, Pennsylvania
TOM O'HALLERAN, Arizona              KELLY ARMSTRONG, North Dakota
KATHLEEN M. RICE, New York
ANGIE CRAIG, Minnesota
KIM SCHRIER, Washington
LORI TRAHAN, Massachusetts
LIZZIE FLETCHER, Texas
                                 ------                                

                           Professional Staff

                   JEFFREY C. CARROLL, Staff Director
                TIFFANY GUARASCIO, Deputy Staff Director
                  NATE HODSON, Minority Staff Director
              Subcommittee on Oversight and Investigations

                        DIANA DeGETTE, Colorado
                                  Chair
ANN M. KUSTER, New Hampshire         H. MORGAN GRIFFITH, Virginia
KATHLEEN M. RICE, New York             Ranking Member
JAN SCHAKOWSKY, Illinois             MICHAEL C. BURGESS, Texas
PAUL TONKO, New York                 DAVID B. McKINLEY, West Virginia
RAUL RUIZ, California                BILLY LONG, Missouri
SCOTT H. PETERS, California          NEAL P. DUNN, Florida
KIM SCHRIER, Washington              JOHN JOYCE, Pennsylvania
LORI TRAHAN, Massachusetts           GARY J. PALMER, Alabama
TOM O'HALLERAN, Arizona              CATHY McMORRIS RODGERS, Washington 
FRANK PALLONE, Jr., New Jersey (ex       (ex officio)
    officio)
                             
                             C O N T E N T S

                              ----------                              
                                                                   Page
Hon. Diana DeGette, a Representative in Congress from the State 
  of Colorado, opening statement.................................     2
    Prepared statement...........................................     4
Hon. H. Morgan Griffith, a Representative in Congress from the 
  Commonwealth of Virginia, opening statement....................     5
    Prepared statement...........................................     6
Hon. Frank Pallone, Jr., a Representative in Congress from the 
  State of New Jersey, opening statement.........................     7
    Prepared statement...........................................     9
Hon. Cathy McMorris Rodgers, a Representative in Congress from 
  the State of Washington, opening statement.....................    10
    Prepared statement...........................................    12

                               Witnesses

Ngozi O. Ezike, M.D., Director, Illinois Department of Public 
  Health.........................................................    14
    Prepared statement...........................................    16
    Answers to submitted questions...............................    83
Joneigh S. Khaldun, M.D., Chief Medical Executive, State of 
  Michigan, and Chief Deputy Director for Health, Michigan 
  Department of Health and Human Services........................    22
    Prepared statement...........................................    24
    Answers to submitted questions...............................    90
Clay Marsh, M.D., Vice President and Executive Dean for Health 
  Sciences, West Virginia University, and COVID-19 Czar, State of 
  West Virginia..................................................    30
    Prepared statement...........................................    32
    Answers to submitted questions...............................    98
Courtney N. Phillips, Ph.D., Secretary, Louisiana Department of 
  Health.........................................................    35
    Prepared statement...........................................    38
    Answers to submitted questions...............................   105
Jill Hunsaker Ryan, Executive Director, Colorado Department of 
  Public Health and Environment..................................    43
    Prepared statement...........................................    45
    Answers to submitted questions...............................   111

                           Submitted Material

Texas State Profile Report: COVID-19, January 21, 2021, submitted 
  by Mr. Burgess.................................................    82

 
  NO TIME TO LOSE: SOLUTIONS TO INCREASE COVID-19 VACCINATIONS IN THE 
                                 STATES

                              ----------                              


                       TUESDAY, FEBRUARY 2, 2021

                  House of Representatives,
      Subcommittee on Oversight and Investigations,
                          Committee on Energy and Commerce,
                                                    Washington, DC.
    The subcommittee met, pursuant to call, at 11:00 a.m., via 
Cisco Webex online video conferencing, Hon. Diana DeGette 
(chair of the subcommittee) presiding.
    Members present: Representatives DeGette, Kuster, Rice, 
Schakowsky, Tonko, Ruiz, Schrier, Trahan, O'Halleran, Pallone 
(ex officio), Griffith (subcommittee ranking member), Burgess, 
McKinley, Dunn, Joyce, Palmer, and Rodgers (ex officio).
    Also present: Representatives Dingell, Soto, Walberg, and 
Carter.
    Staff present: Kevin Barstow, Chief Oversight Counsel; 
Jeffrey C. Carroll, Staff Director; Austin Flack, Policy 
Analyst; Waverly Gordon, General Counsel; Tiffany Guarascio, 
Deputy Staff Director; Perry Hamilton, Deputy Chief Clerk; 
Rebekah Jones, Counsel; Chris Knauer, Oversight Staff Director; 
Mackenzie Kuhl, Digital Assistant; Kevin McAloon, Professional 
Staff Member; Kaitlyn Peel, Digital Director; Peter Rechter, 
Counsel; Tim Robinson, Chief Counsel; Chloe Rodriguez, Deputy 
Chief Clerk; Benjamin Tabor, Junior Professional Staff Member; 
C.J. Young, Deputy Communications Director; Sarah Burke, 
Minority Deputy Staff Director; William Clutterbuck, Minority 
Staff Assistant; Theresa Gambo, Minority Financial and Office 
Administrator; Brittany Havens, Minority Professional Staff 
Member, Oversight and Investigations; Nate Hodson, Minority 
Staff Director; Peter Kielty, Minority General Counsel; Bijan 
Koohmaraie, Minority Chief Counsel; Clare Paoletta, Minority 
Policy Analyst, Health; Brannon Rains, Minority Policy Analyst, 
Consumer Protection and Commerce, Energy, Environment; Alan 
Slobodin, Minority Chief Investigative Counsel, Oversight and 
Investigations; Michael Taggart, Minority Policy Director; and 
Everett Winnick, Minority Director of Information Technology.
    Ms. DeGette. The Energy and Commerce Subcommittee hearing 
will now come to order.
    I am very pleased to convene this first Oversight and 
Investigations hearing of the year. I believe it's one of the 
first in the U.S. Congress, and I want to welcome all of our 
new members. In particular, I want to welcome our new ranking 
member, Morgan Griffith, with whom I've worked on many, many 
issues, and I think will be a wonderful ranking member.
    Before we actually go into business, Morgan, would you like 
to say a few words? I'll yield to you.
    Mr. Griffith. I'm just thrilled to be the Republican leader 
on this subcommittee. It's a subcommittee I've served on since 
I first got to the committee, and I love it and I think we're 
going to do some great work.
    Ms. DeGette. Thank you.
    As Mr. Dingell used to say, our charge is broad--rooting 
out waste, fraud, and, abuse wherever we may find it--and I'm 
sure we'll have many opportunities in the 117th Congress.
    Our hearing today is entitled, ``No Time to Lose: Solutions 
to Increase COVID-19 Vaccinations in the States.'' The purpose 
of the hearing is to examine the distribution and 
administration of COVID-19 vaccines in the United States.
    Due to the COVID-19 public health emergency, as I have 
said, today's hearing is being held remotely, and so all 
Members, witnesses, and staff will participate via video 
conferencing. As part of the proceedings, we ask everybody to 
put their microphone on mute, unless you're speaking, so that--
for the purposes of eliminating inadvertent background noise. 
And every time, of course, you need to speak, then we will ask 
you to unmute.
    If at any time during the hearing I'm unable to chair, the 
chairman of the full committee, Chairman Pallone, who I see on 
my screen, will serve as chair until I'm able to return.
    Documents which are accepted for the record can be sent to 
Austin Flack at the email address we've provided to staff. All 
documents will be entered into the record at the conclusion of 
the hearing.
    And the Chair now recognizes herself for an opening 
statement.

 OPENING STATEMENT OF HON. DIANA DeGETTE, A REPRESENTATIVE IN 
              CONGRESS FROM THE STATE OF COLORADO

    Today, the Oversight and Investigations Subcommittee holds 
its first hearing of the 117th Congress on an issue that holds 
the promise to finally end this pandemic: The rollout of the 
COVID-19 Vaccination Program. This committee has conducted 
relentless oversight of the COVID-19 pandemic response from the 
very start. Last year, we saw endless dysfunction and chaos, as 
our country was adrift by the absence of strong, competent 
Federal leadership. But, as bad as it was last spring, this 
winter has brought an even more dangerous stage.
    In recent weeks, cases and hospitalizations have soared all 
over the country, and as many as 4,000 Americans per day have 
died from this awful virus. And now, as we're seeing, mutations 
of the virus are beginning to spread throughout the United 
States.
    As the title of this hearing makes clear, we have no time 
to lose. We must act with a sense of urgency and use every 
resource available at the Federal, State, and local levels to 
fight the spread of this disease and to end suffering and death 
and to return to normalcy.
    The Biden administration absolutely has its work cut out 
for it. Indeed, it faces the greatest and most immediate 
challenge of any Presidential administration in modern memory. 
But already we're seeing signs that the ship is beginning to 
turn around. The administration recently announced a 
comprehensive national strategy for the COVID-19 pandemic, 
something this committee has long called for. The plan advances 
urgently needed solutions to mount a successful vaccination 
program, restore trust with the American people, and mitigate 
the spread of the virus, while at the same time providing the 
emergency relief that Americans desperately need. We will 
continue to engage with the administration on what the Federal 
Government needs from Congress to execute this plan and to get 
us back on track.
    The key task that we're faced right now is the rollout of 
the COVID vaccines. The portion of Operation Warp Speed, the 
Federal-private partnership to research and develop the 
vaccines, test them in clinical trials for safety and efficacy, 
and get them authorized for use was an enormous undertaking, 
and it was a profound victory for our heroic scientists. But 
that was only the first step.
    If we don't ensure that Americans also get vaccinated 
quickly, the efforts will have been in vain. Those charged with 
administering the COVID-19 vaccine program around the country, 
including our excellent witnesses today, have a tremendous 
opportunity and responsibility to ensure equitable and 
expeditious administration of these lifesaving vaccines. And 
that's why we're convened today, to hear from State leaders on 
the front lines about how we can significantly ramp up 
vaccinations.
    As we will hear, States are mobilizing to expand who will 
be eligible to receive the vaccine next, with a special 
emphasis on ensuring equity for those most vulnerable to COVID-
19 and historically marginalized communities. For instance, my 
home State of Colorado recently announced plans to hold pop-up 
vaccination clinics in 50 high-density, low-income communities 
of color, many in my congressional district.
    Despite these efforts, we have already been seeing a lot of 
frustration and confusion. Since the rollout started in 
December, one consistent theme has been the lack of 
transparency about how many vaccines are coming and when. 
Compounding matters, surveys indicate that, while the majority 
of Americans want to get COVID-19, there are some who still 
have reservations. Thankfully, the Biden administration has 
committed to changes, like transparent data for the States and 
the public, that will address some of those issues so that we 
can build trust and work to get every available vaccine 
administered quickly and equitably.
    In fact, the biggest challenge I'm hearing from States 
right now is simply a lack of supply. After some initial 
challenges in administering the vaccines, State and local 
communities are reporting that now the demand for the vaccine 
far exceeds the supply, and they stand ready to vaccinate many 
more Americans if we can just get them the doses they need.
    As I said, we have an excellent panel today, representing 
five States that are aggressively working to end this pandemic. 
I want to thank each panelist for your efforts, and I'm 
grateful for the time you've committed to provide critical 
testimony on how we can improve our fight against this 
pandemic. I look forward to a candid discussion with the panel 
about what's working and what we can do better. And I hope that 
you will also elaborate on what more the Federal Government and 
Congress can do to improve the partnership in this fight. The 
end of this nightmare is in sight. Now is the time to double 
down on our efforts and finally turn the corner on this 
pandemic.
    [The prepared statement of Ms. DeGette follows:]

                Prepared Statement of Hon. Diana DeGette

    Today, the Oversight and Investigations Subcommittee holds 
the first hearing of the 117th Congress, on an issue that holds 
the promise to finally end this pandemic: the rollout of the 
COVID-19 vaccination program.
    This committee has conducted relentless oversight of the 
COVID-19 pandemic response from the very start. Last year, we 
saw endless dysfunction and chaos as our country was left 
adrift by the absence of strong, competent Federal leadership.
    As bad as it was last spring, this winter has brought an 
even more dangerous surge.
    In recent weeks, cases and hospitalizations were soaring 
all over the country, and as many as 4,000 Americans were dying 
every day from this awful virus.
    As the title of this hearing makes clear, we have no time 
to lose. We must act with a sense of urgency and use every 
resource available--at the Federal, State, and local levels--to 
fight the spread of this virus, end the suffering and death, 
and return to a sense of normalcy.
    The Biden administration has its work cut out for it. 
Indeed, it faces the greatest and most immediate challenge of 
any presidential administration in modern memory. But we are 
already seeing signs of the ship turning around.
    The Biden administration recently announced a comprehensive 
national strategy for the COVID-19 pandemic, something this 
committee has long called for. This plan advances urgently 
needed solutions to mount a successful vaccination program, 
restore trust with the American people, and mitigate the spread 
of the virus, while providing the emergency relief Americans 
desperately need.
    We will continue to engage with the administration on what 
the Federal Government needs from Congress to execute this plan 
and get America on track.
    The key task we are faced with now is the rollout of COVID-
19 vaccines.
    The Federal-private partnership to research and develop 
these vaccines, test them in clinical trials for safety and 
efficacy, and get them authorized for use was an enormous 
undertaking and a profound victory for the country.
    But that was only the first step. If we do not ensure that 
every American is able to get vaccinated quickly, those efforts 
will have been in vain. Those charged with administering the 
COVID-19 vaccine program around the country--including our 
excellent witnesses today--have a tremendous opportunity and 
responsibility to ensure equitable and expeditious 
administration of these lifesaving vaccines.
    That is why we are convened today: to hear from State 
leaders on the front lines about how we can significantly ramp 
up vaccinations.
    As we will hear today, States are mobilizing to expand who 
will be eligible to receive the vaccine next, with a special 
emphasis on ensuring equity for those most vulnerable to COVID-
19 and historically marginalized communities.
    For instance, my home State of Colorado recently announced 
plans to hold popup vaccination clinics in 50 high-density, 
low-income communities of color.
    Despite these efforts, we have also been seeing a lot of 
frustration and confusion. Since the rollout started in 
December, one consistent theme has been the lack of 
transparency about how many vaccines are coming and when. 
Compounding matters, surveys indicate that, while the majority 
of Americans want to get the COVID-19 vaccine, some adults 
continue to have reservations.
    Thankfully, the Biden administration has committed to 
changes--such as transparent data for the States and the 
public--that will address some of those issues, so that we can 
build trust and work to get every available vaccine 
administered quickly and equitably.
    Indeed, the biggest challenge I'm hearing from most States 
now is simply a lack of supply. After some initial challenges 
administering the vaccines, States and local communities are 
reporting that the demand for the vaccine far exceeds the 
supply. And they stand ready to vaccinate many more Americans, 
if they are given the doses they need.
    We have an excellent panel today, representing five States 
aggressively working to end this pandemic.
    I thank them for their efforts, and I'm grateful for the 
time they've committed to provide critical testimony on how to 
improve our fight against this pandemic. I look forward to a 
candid discussion with the panel about what is working and what 
is not working. I hope they will also elaborate on what more 
the Federal Government and Congress can do to improve the 
partnership in this fight.
    The end of this nightmare is in sight. Now is the time to 
double down on our efforts, and finally turn the corner on this 
pandemic.

    Ms. DeGette. And with that, the Chair is pleased to 
recognize the ranking member of the subcommittee, Mr. Griffith, 
for 5 minutes for the purposes of an opening statement.

OPENING STATEMENT OF HON. H. MORGAN GRIFFITH, A REPRESENTATIVE 
         IN CONGRESS FROM THE COMMONWEALTH OF VIRGINIA

    Mr. Griffith. Thank you very much, Chair DeGette. And I 
look forward to working with you, and thank you for holding 
this important hearing.
    I want to thank the State public health officials for 
taking the time to join us today as your vaccination programs 
are well underway. The Federal Government and States are in the 
middle of a monumental task to vaccinate everyone that wishes 
to be vaccinated. I appreciate you all attending today as we 
work together to discuss ways to increase COVID-19 
vaccinations.
    It was just 1 year ago when this country identified the 
first case of a new virus that would rapidly spread throughout 
the Nation. In this past year, the Federal Government and 
States have come together to fight the pandemic, from providing 
testing to therapeutics and, ultimately, a vaccine for 
Americans. Pfizer and Moderna continue to manufacture vaccines 
at full capacity by releasing between 12 million to 18 million 
doses a week to fuel the overwhelming demand from the States.
    Ending the pandemic hinges on the efficacy of the national 
vaccine distribution efforts. This effort includes not only 
sending vaccines to States, but also getting shots into arms. 
To date, the Federal Government has shipped more than 49 
million doses of COVID-19 vaccines to States. States have 
administered almost 28 million of those doses through their 
State vaccination plans, with 3.1 million doses administered to 
people in nursing homes or long-term care facilities. Last 
week, the U.S. averaged 1.2 million doses administered each day 
across the U.S. Sixty-two percent of the vaccine supply has 
been administered, and that continues to trend upwards each 
week.
    This progress is the product of Federal and State 
collaboration, especially extensive planning and investment 
from the initiative Operation Warp Speed. Operation Warp Speed 
was launched in May 2020, to accelerate the development, 
manufacturing, and distribution of COVID-19 vaccines while 
maintaining safety and efficacy standards. This was a massive 
undertaking that combined science, government, the military, 
and the private sector to provide viable vaccines several years 
earlier than typical timelines.
    The Federal Government created toolkits and resources to 
States for planning COVID-19 immunization programs. For 
example, the CDC released a playbook to guide both States and 
their local partners on how to plan and operationalize a 
vaccination response. Additionally, in the summer of 2020, the 
CDC and Operation Warp Speed conducted site visits to develop 
model approaches for vaccinations through five pilot programs 
in California, Florida, Minnesota, North Dakota, and 
Philadelphia. The Federal Government also instructed States on 
how to use vaccines to control the coronavirus.
    Due to the limited supply of vaccine available, the CDC's 
Advisory Committee on Immunization Practices recommended 
priority groups for vaccination. This included healthcare 
personnel and residents of long-term care facilities to be in 
the front of the line, followed by older adults and frontline 
essential workers, all groups with a higher susceptibility to 
coronavirus. States incorporated these recommendations to 
execute a deliberate and measured approach for vaccinations. 
The Federal Government worked diligently to distribute millions 
of doses across the United States. Now States are working 
diligently to administer these doses into arms.
    States have varied in their performance when it comes to 
administering the vaccine doses that have been allocated and 
distributed to their State. For example, Virginia, my home 
State, administers 8.49 doses per 100, with 1.2 percent of the 
population fully vaccinated. In contrast, in West Virginia, 
they administer 13.53 doses per 100, with 3.3 percent of the 
population fully vaccinated.
    States are under criticism for how their vaccination 
campaigns are responding to the demand for shots. States have 
noted the lack of resources and infrastructure for 
vaccinations, such as a lack of trained personnel to administer 
vaccines to eligibility groups. Additionally, miscommunication 
to States and providers on the number of doses available has 
created a chain of logistical issues. States appear to be 
addressing challenges as they learn lessons along the way, but 
there is work to be done to vastly improve the rate of doses 
administered. Additionally, 8.75 billion from the Consolidated 
Appropriations Act enacted at the end of last year with 4.5 
billion specifically allocated to the States is on the way to 
the States and should be of some help.
    As we continue to work on coronavirus stimulus packages, it 
is essential to hear State perspectives. As Justice Brandeis 
said, the States are the laboratories of democracy. By finding 
novel approaches to complex problems, a successful effort by a 
State can be a model for other States looking for solutions to 
similar problems.
    I look forward to the testimony from these witnesses today 
and welcome them to the hearing.
    [The prepared statement of Mr. Griffith follows:]

             Prepared Statement of Hon. H. Morgan Griffith

    Thank you, Chair DeGette, for holding this important 
hearing.
    I also want to thank the State public health officials for 
taking the time to join us today as your vaccination programs 
are well underway. The Federal Government and States are in the 
middle of a monumental task to vaccinate everyone that wishes 
to be vaccinated. I appreciate you all attending today as we 
work together to discuss ways to increase COVID-19 
vaccinations.
    Ending the pandemic in this country hinges on the efficacy 
of the national vaccine distribution efforts. This effort 
includes not only sending vaccines to States, but also getting 
shots into arms. To date, the Federal Government has shipped 47 
million doses of COVID-19 vaccines to States. States have 
administered 26 million of those doses through their State 
vaccination plans with 3.1 million doses administered to people 
in nursing homes or long-term care facilities.
    Last week, the U.S. administered nearly 1.6 million doses 
in one day. This progress is the product of Federal and State 
collaboration, especially extensive planning and investment 
from the initiative Operation Warp Speed.
    Operation Warp Speed was launched in May 2020 to accelerate 
the development, manufacturing, and distribution of COVID-19 
vaccines while maintaining safety and efficacy standards. This 
was a massive undertaking that combined science, government, 
the military, and the private sector to provide viable vaccines 
several years earlier than typical timelines.
    The Federal Government collaborated with States to lend 
toolkits and resources for planning COVID-19 immunization 
programs. For example, the CDC released an interim playbook to 
guide both States and their local partners on how to plan and 
operationalize a vaccination response. Additionally, in the 
summer of 2020, the CDC and Operation Warp Speed conducted site 
visits to develop model approaches for vaccinations through 
five pilot programs in California, Florida, Minnesota, North 
Dakota, and Philadelphia.
    The Federal Government also instructed States on how to use 
vaccines to control the coronavirus. Due to the limited supply 
of vaccine available, the CDC's Advisory Committee on 
Immunization Practices (ACIP) recommended priority groups for 
vaccination. This included healthcare personnel and residents 
of long-term care facilities to be first in line, followed by 
older adults and frontline essential workers, all groups with a 
higher susceptibility to coronavirus. States incorporated these 
recommendations to execute a deliberate and measured approach 
for vaccinations.
    The Federal Government worked diligently to distribute 
millions of doses across the United States. Now, States are 
working diligently to administer these doses into arms. States 
have varied in their performance when it comes to administering 
the vaccine doses that have been allocated and distributed to 
their States.
    States have faced challenges in this complex, logistical 
operation that have contributed to slower than expected 
vaccination rates. This is especially true in my home State of 
Virginia. For example, in Virginia, the State administers 53 
percent of the doses it receives from the Federal Government. 
In contrast, our neighbors in West Virginia administer 77 
percent of their doses. States that are lagging in vaccinations 
fall in the 40 to 50 percent range, while those that are 
leading the country administer 60 to 70 percent of the doses 
they receive.
    States are under criticism for how their vaccination 
campaigns are responding to the demand for shots. States have 
noted the lack of resources and infrastructure for vaccination, 
such as the lack of trained personnel to administer vaccines 
eligibility groups. Additionally, miscommunication to States 
and providers on the number of doses available has created a 
chain of logistical issues. States appear to be addressing 
challenges as they learn lessons along the way, but there is 
work to be done to improve the process. More resources from the 
Consolidated Appropriations Act enacted at the end of last year 
is on the way.
    As we continue to work on coronavirus stimulus packages, it 
is essential to hear State perspectives. With new variants of 
the virus emerging and case numbers skyrocketing, we need to 
find solutions as quickly as possible.
    I look forward to the testimony from these witnesses and 
welcome them to the hearing. I yield back.

    Mr. Griffith. And, Madam Chair--excuse me--Madam or Chair, 
I yield back. Trying to get it right.
    Ms. DeGette. And you did.
    The Chair now will recognize the chairman of the full 
committee, Mr. Pallone, for 5 minutes for purposes of an 
opening statement.

OPENING STATEMENT OF HON. FRANK PALLONE, Jr., A REPRESENTATIVE 
            IN CONGRESS FROM THE STATE OF NEW JERSEY

    Mr. Pallone. Thank you. Thank you, Madam Chairwoman.
    And let me also thank Morgan Griffith, our ranking member. 
And I see the ranking member of our full committee is here as 
well, and I also notice we have a lot of our new Members on 
both sides of the aisle. I think the new Members are probably 
going to be more active than some of the older Members, 
unfortunately. But it's all right. We want you all to get 
involved as much as possible.
    So, today, this is actually the first hearing of the Energy 
and Commerce Committee during the 117th Congress, and obviously 
the purpose of it is to examine the urgent need to increase 
COVID-19 vaccinations. This committee's top priority is to 
combat this pandemic, and in the coming months we'll push an 
aggressive agenda that will ensure the Biden administration has 
all the tools and resources it needs to crush the virus.
    The goal is more pressing than ever. Thousands of Americans 
continue to die each day from COVID-19, while new, more 
contagious strains are emerging in the United States. I'm 
afraid that we're now in a race to keep vaccines ahead of the 
new virus variants, and the stakes could not be higher.
    The pandemic's toll on the Nation is tragic. To date, more 
than 440,000 Americans have lost their lives from COVID-19, 
surpassing the total number of U.S. soldiers killed during 
World War II. More than 10 million Americans are unemployed, 
while one in three households struggle to make ends meet. It's 
no wonder Americans' assessment of their mental health is worse 
than at any point in the past two decades. And experts, of 
course, warned of a dark winter and, unfortunately, they were 
right in these dark days, but we're now seeing the rollout of 
some of the most powerful tools we have to contain the virus: 
That's safe and effective vaccine.
    But, unfortunately, the initial rollout during the Trump 
administration was marked by confusion and delays. It's no 
secret that the demand for a vaccine is outpacing supply, 
leading to canceled appointments, endless lines, and mounting 
concerns, and limited transparency into the Nation's vaccine 
supply as well as conflicting accounts about a reserve held by 
the Federal Government have all contributed to uncertainty and 
frustration.
    But, thankfully, the Biden administration is already taking 
action to address these issues, including purchasing additional 
doses that will increase our vaccine supply by 50 percent by 
the end of summer. And I hope to learn today what more Congress 
and the Federal Government can do to provide more certainty and 
help accelerate vaccinations across the country but at the same 
time ensuring equitable access for the most vulnerable to these 
vaccines.
    And despite the issues we've encountered with the vaccine 
rollout and the painful road still ahead, I'm still optimistic, 
as I noticed Diana DeGette was, about that we can finally be on 
the path to beating the virus. We have to be optimists.
    As I mentioned, there are currently two extraordinarily 
effective and safe COVID-19 vaccines authorized by the FDA, and 
more could be on the way soon, but States have stretched their 
limited resources to implement an unprecedented vaccination 
program, reaching 25 million Americans and counting. As you 
know, I've been very critical that during the Trump 
administration in the last year or so there really was no 
national strategy. States were forced to compete with each 
other, and that led to the confusion. There needs to be a 
national strategy.
    But now, the Biden administration says they're going to be 
guided by science and they're going to have a national strategy 
to beat the pandemic. This is what we've been long calling for. 
But this nationwide vaccination campaign--it really is 
historic, but it's going to require substantial support from 
Congress to succeed.
    To that end, Congress must move swiftly to pass the 
American Rescue Plan, the comprehensive proposal from the Biden 
administration that would fund vaccination efforts and provide 
Americans much-needed relief. This is the new COVID bill. Under 
that bill, we would invest an additional $20 billion in a 
national vaccination program to help ensure greater 
accessibility and availability of vaccines across the country. 
It includes critical financial support to State and local 
governments that have been pleading for more support from the 
Federal Government to assist in their efforts to combat this 
virus.
    So I hope my Republican colleagues will join me without 
delay in supporting this new bill that the Biden administration 
is putting forward. I don't think there's any time to waste. 
And I welcome the State health officials with us. We're going 
to look forward to their assessments of the national 
vaccination effort. You are vital partners in this 
extraordinary campaign. You're being called upon to execute 
innovative solutions to unparalleled challenges, and I want to 
thank you. We understand that you should not have to do this 
without substantial help and a national coordinated effort, and 
we want to know what we can do to achieve that.
    So thank you again, Madam Chairwoman.
    [The prepared statement of Mr. Pallone follows:]

             Prepared Statement of Hon. Frank Pallone, Jr.

    Today, we convene the Energy and Commerce Committee's first 
hearing of the 117th Congress to examine the urgent need to 
increase COVID-19 vaccinations across the country. This 
committee's top priorities this year are to combat this 
pandemic, provide relief to struggling families, and rebuild 
our economy. In the coming months, we will push an aggressive 
agenda that will ensure the Biden administration has all the 
tools and resources it needs to crush this terrible virus.
    This goal is more pressing than ever. Thousands of 
Americans continue to die each day from COVID-19, while new, 
more contagious strains are emerging in the United States. We 
are now in a race to keep vaccines ahead of new virus 
variants--and the stakes could not be higher.
    The pandemic's toll on the Nation is tragic. To date, 
nearly 440,000 Americans have lost their lives from COVID-19--
surpassing the total number of U.S. soldiers killed during 
World War II. More than 10 million Americans are unemployed, 
while one in three households struggles to make ends meet. It's 
no wonder Americans' assessment of their mental health is worse 
than at any point in the past two decades. Experts warned of a 
dark winter, and unfortunately, they were right.
    Amid these dark days, we're now seeing the rollout of some 
of the most powerful tools we have to contain the virus: safe 
and effective vaccines. Unfortunately, the initial rollout has 
been marked by confusion and delays. It's no secret that the 
demand for vaccine is outpacing supply--leading to cancelled 
appointments, endless lines, and mounting concerns.
    Limited transparency into the Nation's vaccine supply, as 
well as conflicting accounts about a reserve held by the 
Federal Government, have all contributed to uncertainty and 
frustration.
    Thankfully, the Biden administration is already taking 
action to address these issues, including purchasing additional 
doses that will increase our vaccine supply by 50 percent by 
the end of summer. I hope to learn today what more Congress and 
the Federal Government can do to provide more certainty and 
help accelerate vaccinations across the country, while ensuring 
equitable access for those most vulnerable to COVID-19.
    Despite the issues we've encountered with the vaccine 
rollout and the painful road still ahead, I'm optimistic that 
we are finally on a path to beating the virus.
    As I mentioned, there are currently two extraordinarily 
effective and safe COVID-19 vaccines authorized by the Food and 
Drug Administration--and more could soon be on the way.
    States have stretched their limited resources to implement 
an unprecedented vaccination program, reaching 26 million 
Americans and counting.
    And we now have a new administration that will be guided by 
science and a comprehensive national strategy to beat the 
pandemic--something I have long called for.
    So there is hope on the horizon, but we have much work to 
do to get there. That starts with tackling the biggest 
challenges standing in the way of containing the pandemic: 
getting vaccines into as many arms as possible, as quickly as 
possible.
    This nationwide vaccination campaign is truly historic, and 
it will require substantial support from Congress to succeed.
    To that end, Democrats in Congress are moving swiftly to 
pass the American Rescue Plan--a bold, comprehensive proposal 
from the Biden administration that would fund vaccination 
efforts and provide Americans much-needed relief. Critically, 
the plan would invest $20 billion in a national vaccination 
program to help ensure greater accessibility and availability 
of vaccines across the country.
    It includes critical financial support to State and local 
governments, which have been pleading for any support from the 
Federal Government to assist in their efforts to combat this 
virus.
    I hope my Republican colleagues will join me, without 
delay, in supporting this bill for the American people. There 
is simply no time to waste.
    I welcome the State health officials with us and look 
forward to their on-the-ground assessments of the national 
COVID-19 vaccination effort. You are our vital partners in this 
extraordinary campaign, and you are being called upon to 
execute innovative solutions to unparalleled challenges. Thank 
you for dedicating your valuable time to sharing your important 
perspectives with the committee today.
    The COVID-19 vaccines authorized in the United States are 
potent tools in our fight against the virus. But vaccines in 
vials don't protect people--vaccines in arms do. We must act 
now to overcome the remaining logistical hurdles and strengthen 
the Nation's COVID-19 vaccination campaign. There is no time to 
lose.

    Ms. DeGette. Thank you very much.
    The gentleman yields back.
    The Chair now is happy to recognize the ranking member of 
the full committee, Mrs. Rodgers, for 5 minutes for the 
purposes of an opening statement.

      OPENING STATEMENT OF HON. CATHY McMORRIS RODGERS, A 
    REPRESENTATIVE IN CONGRESS FROM THE STATE OF WASHINGTON

    Mrs. Rodgers. Thank you, Madam Chair.
    And the Republican leader, Mr. Griffith, as well as 
everyone, just I'm really pleased that we're coming together 
this morning to address the solutions to increase COVID-19 
vaccinations in the United States. Welcome to our new Members.
    And to those that are on the front lines, the State health 
officials that are with us today, thank you for your continued 
vigilance.
    The development and the approval of several COVID-19 
vaccines in less than a year is one of the greatest 
achievements in American history and modern science. I'm also 
grateful for the work that has been done in Congress. The fact 
that Congress passed, in a matter of days, the CARES Act almost 
a year ago, and then just in December an additional $900 
billion that was passed by Congress--overwhelming bipartisan 
support, again, to meet the needs of Americans.
    The Trump administration and the public-private partnership 
of Operation Warp Speed set ambitious goals that many doubted 
could be achieved. Yet less than a year into this pandemic, we 
have vaccinated tens of millions of Americans. Our work is not 
over, however, and there are many challenges ahead of us. We 
must vaccinate as many Americans as quickly as possible so that 
we can save lives, get our economy and schools back open, and 
get our lives back.
    The distribution of these vaccines should be approached 
with the same level of ambition as Operation Warp Speed. We 
absolutely must continue to act with a sense of urgency. This 
is an extremely complex process involving a system of 
transportation, equipment, personnel, and 64 different 
jurisdictions, including all States and territories. We must 
recognize and appreciate that the distribution and 
administration of COVID-19 vaccines is one of the most 
ambitious, complex, and important logistical operations ever 
undertaken in the United States. Such an enormous operation was 
bound to run into difficulties.
    But, as we look at solutions, it's important that we not 
just look at new ideas, but also take a look at the remarkable 
foundation that we're building on, as well as the assets and 
resources already in place that can be part of the solution.
    The foundation of Operation Warp Speed is amazing. This 
effort to have two vaccines with about 97 percent efficacy in 
response to a novel pandemic virus before the end of 2020 is 
epic and historic. Many skeptics said it couldn't happen. 
Actions by Operation Warp Speed and the Department of Defense 
also ensured the supply of syringes, needles, and other 
essential supplies, to support the vaccination efforts that are 
underway. This has been and will continue to be an all-of-
government approach, and we're eager to hear from our witnesses 
representing State governments.
    As an oversight subcommittee, our job is to find out what's 
working, what isn't, and then find solutions to improve our 
COVID-19 vaccine distribution and administration efforts. E&C 
Republicans are committed to working on solutions to increased 
vaccinations, and we're ready to engage in a serious and 
credible way. I hope that the new administration, President 
Biden and the officials, will stop trying to rewrite history 
and stop, you know, saying that this was a dismal failure. Our 
goal needs to be continuing to build upon the great foundation.
    President Biden's goal pace of 1 million doses administered 
a day was already reached. States such as Washington and New 
York are attempting to shift blame from their own significant 
shortcomings by complaining about the Trump administration and 
putting the entire onus for distribution and administration on 
the Federal response.
    As we will hear from our witnesses today, a localized 
response can often best meet the unique challenges of 
individual States. West Virginia is very different from 
Washington State and has been successful.
    Contrary to this administration and certain Governors' 
assertion, vaccine distribution plans did exist. In fact, as of 
January 31st, more than 49.9 million vaccine doses have been 
distributed, 31 million administered.
    President Biden says our country is at war with the 
coronavirus. I agree. When we fight wars and do it 
successfully, we have to do it united, not by using partisan 
political tactics like budget reconciliation. Let's work 
together on boosting our COVID-19 vaccine distribution efforts 
and prepare for future pandemics so this doesn't happen again. 
I hope this hearing helps put Congress on a constructive path 
with the President to deliver results.
    Thank you, Madam Chair. I yield back.
    [The prepared statement of Mrs. Rodgers follows:]

           Prepared Statement of Hon. Cathy McMorris Rodgers

    Thank you, Chair Eshoo and Republican Leader Guthrie, for 
holding this important hearing.
    Exactly one year ago today, news outlets were reporting 
that the global death toll from the coronavirus was 362, with 
all but one of those deaths occurring in mainland China.
    A year later, and this heartbreaking number has surpassed 2 
million, with over 425,000 of these tragic deaths occurring in 
the United States.
    This pandemic has wreaked havoc on our way of life. The 
loss of life has been devasting.
    Our previously booming economy has been decimated.
    Our mental health crisis has only worsened.
    And the long-term impact on our children being kept out of 
the classroom is incalculable.
    Last Congress, we put our political differences aside to 
make extraordinary investments in the fight against COVID-19 
through five separate bipartisan relief packages.
    These included providing over 30 billion dollars for 
States, territories, and Tribes for testing, vaccine 
distribution, contact tracing, and public health data 
infrastructure improvement.
    And over 23 billion dollars to the Biomedical Advanced 
Research and Development Authority for the research, 
development, and manufacture of novel vaccines, tests, and 
treatments.
    And 178 billion dollars for healthcare providers on the 
front lines of taking care of patients with COVID-19.
    This investment and partnership with the private sector has 
led to the unprecedented development of innovative vaccines and 
treatments coming to market faster than we ever thought 
possible.
    Operation Warp Speed is one of the most ambitious and 
successful undertakings in American history, and with two 
lifesaving vaccines now authorized by the FDA, and a third 
hopefully soon to follow, there is light at the end of this 
dark tunnel.
    However, our hard work is not yet complete.
    Vaccine distribution is ramping up, but we must ensure 
States have the resources and flexibility they need to immunize 
successfully as many people who want it, and meet the unique 
health needs of their individual populations.
    We heard yesterday in the Oversight and Investigations 
Subcommittee from West Virginia, which has relied on community 
pharmacies to get the vaccines to people.
    Unfortunately, Washington State has not been as successful. 
Gov. Inslee and others in Olympia spend a great deal of time 
pointing fingers at Washington, DC, for the State's slow 
distribution instead of figuring out strategies to get people 
vaccinated as West Virginia is doing.
    Clearly, some States were better prepared and used the 
advice of the CDC career scientists to implement locally 
targeted strategies more successfully than he has done.
SUPPLY CHAIN
    While vaccine distribution is critical to safely and 
responsibly reopen our economy and our schools, we also learned 
additional challenges during the response to COVID-19.
    We learned that our medical supply chain is incredibly 
vulnerable and that we rely too heavily on adversarial 
countries such as China for critically important products, such 
as personal protective equipment.
    We need to consider policies that will improve our domestic 
manufacturing without impacting cost and consumer access.
    Our strategic national stockpile and medical supply 
distribution logistics also need to be strengthened.
    While we have met this unprecedented crisis with an equally 
unprecedented response, our resources are not unlimited.
    Congress has a responsibility to oversee the money we have 
spent, understand how it is being distributed and used, and 
learn what's working and what hasn't.
    As Chairman Pallone said during our organizing meeting last 
week, this committee has a rich history of bipartisan 
cooperation and hard work, perhaps more so than any other 
committee in Congress.
    Between the pandemic, the economic crisis, and the social 
and political unrest, last year was one of the most difficult 
in our Nation's history.
    Yet, despite these incredible hurdles, Congress was able to 
come together on five separate occasions to give the American 
people the relief they needed.
    This pandemic, and our Government's response, is bigger 
than any single administration or political party.
    As we discuss these important issues and our path forward 
with our distinguished witnesses today, I hope our focus will 
be not about pointing fingers for our shortcomings, but an 
opportunity to learn what bipartisan steps we can take over the 
next several months to win the fight against COVID-19, restore 
our way of life, rebuild the greatest economy in history, and 
prepare for future pandemics so that a public health emergency 
of this magnitude never happens again.
    Thank you to our witnesses for joining us today, and I 
yield back the balance of my time.

    Ms. DeGette. I thank the gentlelady.
    The Chair now asks unanimous consent that the Members' 
written opening statements be made part of the record, and 
without objection, so ordered.
    I would now like to introduce our witnesses for today's 
hearing: Dr. Ngozi Ezike, who's the director of the Illinois 
Department of Public Health; Dr. Joneigh Khaldun, who's the 
chief medical executive and chief deputy director for 
Michigan's Department of Health and Human Services.
    If people can please put their mics on mute.
    Dr. Clay Marsh, the West Virginia COVID-19/coronavirus 
czar.
    Mr. McKinley, I guess you guys have czars down there in 
West Virginia.
    Dr. Courtney N. Phillips, the secretary of the Louisiana 
Department of Health; and Director Jill Hunsaker Ryan, who's 
the executive director of the Colorado Department of Public 
Health and Environment.
    I want to thank all of our witnesses again for appearing in 
front of this committee. Every member of this committee 
appreciates it, because we know how busy you are.
    I know all of you are aware that the committee is holding 
an investigative hearing, and as such we hold all of our 
hearings under oath. Does anyone here have any objection to 
testifying under oath?
    Let the record reflect that the witnesses have responded 
no.
    The Chair then advises you that, under the rules of the 
House and the rules of the committee, you are entitled to be 
represented by counsel. Does any of our witnesses ask to be 
represented by counsel?
    Let the record reflect that the witnesses have responded 
no.
    If you would, please, could you please raise your right 
hand so that I may swear you in?
    You can unmute and say, ``I do.''
    [Witnesses sworn.]
    Ms. DeGette. Let the record reflect the witnesses have 
responded affirmatively. And you are now under oath and subject 
to the penalties set forth in Title 18, section 1001, of the 
U.S. Code.
    The Chair will now recognize our witnesses for a 5-minute 
summary of their written statement. There's a timer on the 
screen right here that will count down your time, and it will 
turn red when your 5 minutes has come to an end. And so I will 
now recognize each of our witnesses.
    Dr. Ezike, you are recognized first for 5 minutes, please.



    STATEMENTS OF NGOZI O. EZIKE, M.D., DIRECTOR, ILLINOIS 
 DEPARTMENT OF PUBLIC HEALTH; JONEIGH S. KHALDUN, M.D., CHIEF 
MEDICAL EXECUTIVE, STATE OF MICHIGAN, AND CHIEF DEPUTY DIRECTOR 
 FOR HEALTH, MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES; 
CLAY MARSH, M.D., VICE PRESIDENT AND EXECUTIVE DEAN FOR HEALTH 
SCIENCES, WEST VIRGINIA UNIVERSITY, AND COVID-19 CZAR, STATE OF 
    WEST VIRGINIA; COURTNEY N. PHILLIPS, Ph.D., SECRETARY, 
    LOUISIANA DEPARTMENT OF HEALTH; AND JILL HUNSAKER RYAN, 
 EXECUTIVE DIRECTOR, COLORADO DEPARTMENT OF PUBLIC HEALTH AND 
                          ENVIRONMENT

               STATEMENT OF NGOZI O. EZIKE, M.D.

    Dr. Ezike. Thank you.
    Chairwoman DeGette, Ranking Member Griffith, and 
distinguished members of the subcommittee, thank you for having 
me here today to speak about Illinois' response to the 
coronavirus pandemic.
    Over the past year in Illinois, we've had more than 1 
million cases of COVID-19 and, unfortunately, have lost more 
than 19,000 members of our Illinois family. But through 
efficient and effective distribution of the vaccine, coupled 
with a continued focus on masking, social distancing, and hand 
hygiene, we can suppress the spread of the virus and save many 
lives.
    Within 24 hours of receiving our first allocation of over 
40,000 doses, IDPH distributed the entire allocation to local 
health departments, with subsequent distribution to hospitals. 
We continue to build a statewide provider network to ensure 
vaccination occurs with both rapidity and equity.
    From the outset, vaccination efforts in Illinois and 
throughout the States have been limited by vaccine supply and 
sometimes complicated by inconsistent messages regarding 
allocations. Operation Warp Speed's promise to Illinois and the 
Nation of a steady cadence of vaccine oftentimes fell short, 
with reduced or postponed allocations, which left Illinois 
receiving fewer than expected doses.
    After meticulous planning to vaccinate the target 
population for Illinois' Phase 1B, which was shaped by the 
Advisory Committee on Immunization Practices' recommendations, 
the previous administration did change the priority groups 
without forewarning, further complicating our efforts by 
confusing the public and nearly doubling the size of the target 
population that now heard that they were eligible.
    Last month, Governor JB Pritzker activated the Illinois 
National Guard to assist local health departments in 
administering vaccinations. The Biden administration supported 
that move by approving 100 percent of the cost, but we continue 
to need assistance.
    With our significant engagement, Illinois pharmacies in the 
Federal Pharmacy Partnership program have vaccinated many of 
our long-term care residents in nearly 1,700 facilities 
assigned to them. And, as of January 25th, every resident and 
staff person in the Illinois skilled nursing facilities have 
been offered that first dose.
    While we await additional vaccine supply, a multipronged 
approach supported by the Federal Government could help improve 
the effectiveness of nonpharmaceutical interventions, actions 
apart from getting vaccines and/or taking medicines that will 
slow the spread of the illness. Examples include aggressive 
expansion of genomic sequencing. That infrastructure is needed 
for accurate and timely assessment of the threat and the 
identification of new variants.
    Another critical piece with heightened application in 
economically disadvantaged communities is the continuation of 
paid sick leave and direct financial support to encourage 
compliance with distancing, quarantine, and isolation orders.
    As of yesterday, the 1 millionth dose was administered into 
an Illinois resident. But to accelerate immunizations we need 
our Federal partners to align our efforts--align their efforts 
with ours to help solve practical operational issues.
    Of course, we need increased supply of vaccines as well as 
resources to quickly administer the vaccine. We need improved 
communication channels and fixes to tools provided to States. 
The Federal Government should provide States with clear, 
consistent projections for vaccine allocation to allow and 
enable planning weeks into the future, and continue to update 
the Tiberius system so that States are working with clear, 
accurate information and can make appropriate plans. We also 
need a robust IT solution connecting electronic medical 
records, pharmacy logs, and State registration tools so people 
can locate vaccines across the jurisdictions.
    We're grateful for the influx of funding. And, as you 
consider the next round of emergency supplemental funding, I 
encourage you to provide additional funds to support the 
ongoing vaccination campaign and address emerging funding needs 
for State, local, Tribal, and territorial public health 
systems.
    Thank you for the opportunity to share Illinois' 
experience. We will continue to let data, science, and equity 
guide our approach. And I'm honored to work with Congress and 
the new administration to get to the other side of this 
pandemic.
    Thank you for your attention.
    [The prepared statement of Dr. Ezike follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you very much.
    Our next witness is Dr. Joneigh Khaldun, who's the chief 
medical executive and chief deputy director of the Michigan 
Department of Health and Human Services.
    Dr. Khaldun.

             STATEMENT OF JONEIGH S. KHALDUN, M.D.

    Dr. Khaldun. Thank you.
    Chairs Pallone and DeGette, Ranking Members Rodgers and 
Griffith, and distinguished members of the committee, thank you 
for the opportunity to speak with you today about Michigan's 
COVID-19 vaccination efforts. A focus on efficient and 
equitable distribution of these vaccines is the way that we are 
going to end this pandemic.
    I have the honor of serving my State, not only helping to 
guide the battle against COVID-19 in my role as chief medical 
executive, but also as a practicing emergency physician on the 
front lines treating patients in Detroit, one of the hardest-
hit cities by the pandemic early on. I've seen the terrible 
impact this pandemic has had on patients, families, and on my 
clinical colleagues. In fact, two colleagues that helped train 
me in New York City lost their lives to this pandemic last 
year. I only wish these vaccines were available sooner so that 
they might be alive today.
    For me, this vaccination effort is personal, for my 
community, for my colleagues, and for my patients. Michigan is 
working hard to distribute the vaccine quickly, efficiently, 
and equitably to the nearly 10 million residents across the 
State. We have a robust network of over 2,000 enrolled 
providers and have the capacity to administer up to 80,000 
vaccines a day. However, Michigan's biggest challenge with the 
vaccine rollout has been the limited supply of vaccine, lack of 
predictability regarding vaccine amounts week to week, and the 
lack of a national strategy until now.
    Despite this, Michigan has made significant strides. 
Yesterday, we announced surpassing 1 million doses of vaccine 
being administered statewide, and we have jumped more than 20 
places in the rankings over the past few weeks as it relates to 
our proportion of the population vaccinated.
    Michigan has made this progress because we have been 
intentional and focused. We have set forth clear goals for our 
State and vaccinating partners, with the expectation that 90 
percent of received vaccines are administered within 7 days.
    We are also laser-focused on equity. We have set the 
ambitious but attainable goal of having no disparity in 
vaccination rates across racial and ethnic groups. It is 
important that vaccination efforts move forward expeditiously 
without compromising equity.
    It's a tragedy but not a surprise that COVID-19 has 
disproportionately impacted communities of color. This 
disparity is directly related to structural inequities and 
historical racism that has caused communities of color to have 
less access to the resources needed to achieve optimal health. 
Michigan has been a leader in fighting COVID-19 disparities, 
essentially eliminating the disparity between African Americans 
and Whites when it comes to COVID-19 cases and deaths. We did 
this specifically by engaging trusted community members, using 
data to identify testing locations, and developing strategic 
messaging in collaboration with communities of color.
    We are building on this success in our vaccination efforts, 
prioritizing allocation to socially vulnerable groups, 
mobilizing a diverse network of vaccinators that can go into 
neighborhoods, and launching an aggressive communications and 
engagement effort to address hesitancy and misinformation. What 
we need at the Federal level is a larger and consistent vaccine 
supply, as well as additional funding to specifically address 
barriers to access.
    Data and reporting having been a challenge throughout this 
pandemic, with the vaccine rollout being no exception. States 
must manage multiple systems to understand, track, and report 
vaccines, and our providers are overburdened by onerous 
enrollment, tracking, and reporting systems. This has led to 
delays and inaccuracies in data reporting.
    Additionally, the CDC website is often inaccurate, 
outdated, or does not fully reflect the work of States. 
Improvements in data reporting would ease the burden on States 
and allow us to focus on implementation of our vaccination 
strategies.
    Finally, I'd like to thank Congress for passing emergency 
supplemental funding for the vaccination response, which will 
help Michigan build out its vaccination infrastructure. We have 
also requested additional support from FEMA to expand mass 
vaccination sites as well as mobile clinics. We look forward to 
continuing to partner with the Biden administration on these 
efforts.
    Overall, I'm pleased with the progress that we've made in 
Michigan. We have built out capacity and a strategy that will 
prioritize speed without compromising equity. I'm grateful for 
our Federal partners, encouraged by the leadership and 
engagement demonstrated by President Biden and his team, and 
look forward to continuing to work together to end this 
pandemic.
    Thank you very much.
    [The prepared statement of Dr. Khaldun follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Doctor.
    I'm now very pleased to recognize our colleague, Mr. 
McKinley, to introduce our next witness.
    Mr. McKinley. I have to unmute. There we go.
    Thank you, Madam Chair. Did I say that properly? Madam 
Chair?
    Ms. DeGette. That's perfect. Thank you.
    Mr. McKinley. Madam Chair, I'd like to introduce Dr. Clay 
Marsh. Dr. Marsh is the current virus czar for the State of 
West Virginia. And along with his role, he's also the vice 
president and dean for Health Sciences at West Virginia 
University, and is considered to be a national leader in 
healthcare.
    He's published more than 140 papers in peer-reviewed 
journals, but I first met his father 40 years ago. Don Marsh 
was a longtime editor of the largest newspaper in West 
Virginia, one, quite frankly, not particularly friendly to 
Republicans. But Don was always fair and objective. So I expect 
nothing less than that from Clay as we welcome him to his 
presentation today.
    Thank you.
    Ms. DeGette. I thank the gentleman.
    Dr. Marsh, you're recognized for 5 minutes.

                 STATEMENT OF CLAY MARSH, M.D.

    Dr. Marsh. Thank you, and good morning, Chairman Pallone, 
Ranking Member Rodgers, Subcommittee Chairwoman DeGette, 
Subcommittee Ranking Member Griffith, and other members of the 
House Energy and Commerce subcommittee.
    It is really a distinct pleasure and privilege to be here 
today, and I want to recognize and thank Congressman McKinley, 
who is unwavering in his support for West Virginia, and also to 
recognize Governor Justice, who's done a remarkable job as a 
leader.
    What I'd like to do in my time here is to reflect what our 
strategies have been and talk a bit about the important 
components I believe could be shared, and certainly learn from 
other people.
    I congratulate the other presenters.
    In West Virginia, we recognize that ultimately it is 
culture that plays the most important role in outcome. We were 
very much impressed by a series of articles that we read at the 
beginning of the pandemic, one of which reflected four 
mathematical models, agent-based models, that demonstrated that 
doing nothing to mitigate the COVID-19 pandemic or doing things 
by force were not as effective as doing things collaboratively. 
And that's really been a hallmark of what we've tried to do, is 
really move toward a level of committed purpose and service to 
people in our State.
    We recognized early that this pandemic was a ``black swan'' 
event, a rare event that had catastrophic perturbation of all 
of our systems, and therefore we knew we couldn't predict 
necessarily the future, but we wanted to become agile and be 
capable of changing and trying things and undergoing rapid 
learning.
    We've created a team-of-teams kind of approach that's been 
led by our National Guard, our logistics experts, choosing the 
most expert people to lead the part of the response meta that 
we could muster in West Virginia. And the great thing about 
West Virginia is, although people may represent different 
sectors, they all eventually wear the West Virginia hat.
    As we started to focus and clarify our priorities, we 
agreed with the Advisory Committee on Immunization Practices 
but also were informed by data from the United Kingdom and also 
from the CDC that demonstrated truly that older patients were 
the most vulnerable for death and hospitalization. And the 
Governor gave us a directive to save lives, to improve well-
being, and to maintain the capacity and the function of vital 
healthcare and industry sectors in West Virginia.
    As we looked at our own data, we saw that the average age 
of death was 77 years old, 77.5 percent of our citizens who 
died were over 70, 92 percent over 60, 97 percent over 50. So 
we targeted this age group, along with the vulnerable 
populations outlined by the CDC.
    And I'm really proud to say, as we started to look at our 
own State's needs, we figured out that we had about 250 
pharmacies in West Virginia, half of which were privately 
owned. So, instead of activating the Federal programs, we went 
a different direction and started partnering these pharmacies 
with nursing homes, and we were able to immunize all of our 
nursing home/assisted living residents before the new year, and 
we just finished on our second dose, which has been great 
because we know half of our deaths come from this population.
    And so, as we start to work to move vaccines quickly, our 
goal is to move every vaccine within 5 days to somebody's arm 
in West Virginia, answering the risk of our State as predicted 
and projected by the Kaiser Family Foundation, the most 
vulnerable State moving into this pandemic. We're really proud 
to say that we have now immunized 80,000 of 350,000 over-65-
year-old West Virginians, and we're moving forward. And to try 
to reduce the confusion about vaccination, we have now started 
a preregistration system, and we're hoping to preregister every 
person in the State.
    I would end by saying that we believe that we all shine 
brightest in the service to others, and the only way that we're 
going to succeed is together, not only as West Virginians, but 
as Americans, and I'm very proud to represent our State today. 
And thank you very much for what you're doing.
    [The prepared statement of Dr. Marsh follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Doctor.
    I'm now pleased to recognize Dr. Courtney Phillips, the 
secretary of the Louisiana Department of Health.
    Dr. Phillips.

            STATEMENT OF COURTNEY N. PHILLIPS, Ph.D.

    Dr. Phillips. Good morning, Chairwoman DeGette, Ranking 
Member Griffith, and members of the subcommittee. As mentioned, 
I'm Courtney Phillips, and I have the pleasure of serving as 
the secretary for the Louisiana Department of Health. First, 
thank you all for the invitation to share our journey in the 
distribution of COVID-19 vaccines, both our successes as well 
as opportunities we have working together for continual 
advancement.
    With our continued partnership, we are confident we'll be 
able to clear these initial hurdles, namely through increased 
COVID-19 vaccine allocations, advanced notice of allocation 
amounts for planning, and continued flexibility around the 
long-term care partnership program.
    Although Louisiana has a strong track record of hosting 
mass vac events and is ready to employ them once vaccine 
availability increases, from the start of our planning we put 
our energy towards a low-and-wide strategy for vaccine 
distribution. We work with our partners to get local providers 
across the State enrolled and comfortable with the logistics of 
vaccine receipt and administration. This allowed us to build a 
vast network of diverse providers, which was time and labor 
intensive, but we do know it was fundamental in achieving 
equitable coverage, which has been a top priority in our 
planning and rollout from the start.
    Per CDC rankings, Louisiana currently ranks 14th for our 
first dose administering. While we're proud of the progress 
we've made over the past several weeks, we're not satisfied 
with where we stand, and we're determined to keep getting 
better, determined to be our best selves. Louisianans not only 
desire it, but they also deserve it. They're depending on us. 
Their lives are dependent upon all of us pulling together in 
getting this done.
    To date, Louisiana has been allocated a little over 505,000 
doses, first doses across our State. More than 93,000 of those 
first doses were diverted to the Pharmacy Partnership Long-Term 
Care Program, which left about 411,000 for in-State allocation. 
Thus far, if you back out this week's allocation, we've 
allocated more than 90 percent of our doses within the 
community. And we aim to release at least 90 to 95 percent of 
doses on a weekly basis when it's received.
    This week's allocation is being spread across 406 providers 
in every parish in our State. On average, we've increased the 
number of provider sites by 65 per week. Our provider sites 
include hospitals, outpatient clinics, federally qualified 
health centers, rural health clinics, independent and chain 
pharmacies, home health agencies, and other healthcare 
facilities.
    Over the past week, we've tested additional distribution 
models, including providing Pfizer vaccines in nonhospital 
settings. We're preparing for when increased supply is 
available, and that preparation isn't limited to just 
distribution models, but it also includes increasing the number 
of providers enrolled and ready to receive.
    Although supply does not yet support the need for 
additional providers, we want to be ready when the time comes. 
We initially began this with 701 providers enrolled in week one 
and now have over 1,900 providers enrolled across our State. 
These providers are spread out all across Louisiana in urban, 
rural, and underserved communities. They are ready to receive 
and administer vaccine.
    That being said, currently only 32 percent of these 
providers have been able to receive vaccines because of the 
limited supply. And although we have more than 1,900 providers 
ready and waiting, we still recognize that we do have some 
areas across our State that are healthcare provider deserts. 
And to combat this, we're working and gearing up with our local 
community partners to deploy mobile vaccine teams, and some of 
the recent funding will allows us to do this.
    With additional supply, the proper time to strategically 
plan, and continued flexibility as to where our vaccine doses 
go, Louisiana will be able to significantly increase the number 
of residents vaccinated each week. So your continual support in 
these areas are needed. And we relayed to you increased supply, 
we're ready. I think most States are. Our provider partners and 
residents are equipped to handle this increased allocation.
    When we talk about the extremely high level of COVID across 
our Nation and here in Louisiana--we recently surpassed 400,000 
cases--take a moment to step back and think about it. That's 
every person in the New Orleans--and then some--area having had 
COVID-19.
    The narrative across the country has been that vaccines are 
going unused and sitting on shelves, so we've worked very hard 
in our State to ensure that the limited supply that we've 
received from our Federal partners is going into eligible 
residents' arms each week, and we've done well. We pushed to a 
point where we range from 90 to 95 percent of first-doses 
vaccines in the arms of Louisianans within the week that they 
receive it. Our providers' weekly dose requirements requests 
top 150,000 doses each week. They are ready and asking for 
more, and we believe that an increased allotment we can handle 
in our State.
    Our second area, as mentioned, advance notice. Providing 
advance-notice allocation notice would allow the State and our 
providers more time to strategically plan. Typically, our week 
begins on Tuesday when Louisiana receives an estimated 
allocation for the following week. Based on those numbers, the 
department works with local providers to determine the need for 
the coming week. This list is compiled on Wednesday. Once we 
receive firm numbers on Thursdays, we begin the order and load 
it into the system. We don't ever lock in before Thursday, 
because there's been a couple of instances that those numbers 
have changed from Tuesday to Thursday.
    Once our order is loaded and submitted, we work with our 
providers over Friday and Saturday to make them aware of what's 
coming. Monday is shipment, and we begin our process all over 
again. But providing States with greater visibility on what's 
expected in weeks in advance allows States time to plan and 
distribute vaccines more efficiently. This also allows 
providers time to adjust for staffing needs based on what 
they're going to receive and allow appointments to be scheduled 
further in advance.
    We were definitely encouraged by the news last week from 
our Federal partners that States will be given more notice on 
what they can expect to receive, and we do hope that this will 
continue. This will be a help.
    A third ask that we have is continued flexibility in the 
long-term care partnership with both CVS and Walgreens. This 
flexibility will allow us to get shots in arms even faster.
    Let me begin by expressing our appreciation for these 
corporate partners for their responsiveness on issues as they 
surface. But continual improvements and proactive 
communication, awareness, and the speed of vaccinations are 
going to be key.
    In recent weeks, we've received approximately 58,000 first 
doses, and a large allotment of that goes to a long-term care 
partnership. Fortunately, we requested and have received 
approval in the recent weeks to keep and utilize those doses 
that have gone to the partnership, which has allowed us to 
further expand our network within the community in 
vaccinations. We're grateful for this flexibility and ask that 
it continues.
    Ms. DeGette. Doctor, if you could please wind up. Thank 
you.
    Dr. Phillips. Yes, ma'am. Thank you.
    As we continue to move forward, we just want to thank you 
all for the financial assistance. Financial burden has been key 
in our State. And so the assistance that's been provided in 
terms of the FEMA reimbursement, the 100 percent reimbursement 
to the National Guard, and the grants have allowed us to be 
able to move forward. We need this continued relief as we try 
to support the challenges we're up ahead.
    Thank you, Chairwoman and committee members, for this time 
and any questions, more than happy to once we wrap up. Thank 
you.
    [The prepared statement of Dr. Phillips follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Doctor.
    And last but surely not least is my wonderful executive 
director of the Colorado Department of Public Health and 
Environment, Dr. Jill Hunsaker Ryan.
    Doctor, welcome. Glad to see you here. And you're 
recognized for 5 minutes.

                STATEMENT OF JILL HUNSAKER RYAN

    Ms. Ryan. Thank you, Madam Chair.
    And just to clarify, I'm not a physician. So you all may 
call me Director Ryan. My background is epidemiology.
    But thank you, Chairman DeGette, Ranking Member Morgan 
Griffith, and members of the subcommittee. I'm so happy to be 
with you here today, and thank you for all of your support so 
far.
    I'm joining today from Eagle County in Colorado. In 
Colorado, we're very proud of our response to the COVID-19 
pandemic. We currently have the fifth-lowest rate of 
transmission in the Nation and are ranked eighth in terms of 
the percentage of vaccine supplies used. Part of our success is 
a whole-government approach with the Colorado Department of 
Public Health and Environment in unified command with the 
Colorado Department of Public Safety, the Governor's office, 
and using the Colorado National Guard to support COVID-19 
testing and vaccine distribution.
    Colorado received the first shipment of vaccine on December 
14th, with the Governor signing for it himself. We are moving 
as fast as the Federal supply chain allows and are grateful for 
every vaccine we receive. When the pandemic began, if you would 
have asked me or if you would have told me that we would have 
not only one but several vaccines would be in clinical trials 
within the year, with distribution starting before 2021, I 
would have been very skeptical, but here we are, and this is 
simply unprecedented.
    Operation Warp Speed deserves our thanks and praise for the 
public-private partnership in developing these vaccines, which 
will be a game changer in supporting the long-term health and 
well-being of our schools, our families, and our communities.
    General Perna and his team deserve credit too for efficient 
distribution. General Perna has told me that the vaccine is 
going from the conveyor belt directly to States.
    Colorado's currently receiving about 80,000 doses per week, 
and we hear that will increase to 96,000 in mid-February. We do 
have the capacity to administer 300,000 doses a week now, with 
the goal of 400,000 by the beginning of March.
    So our main ask is for more doses and, if possible, greater 
predictability in our weekly allotment, which simply helps our 
ability to plan. For example, if we knew our number of doses a 
month out, with increased supply we could plan even larger 
additional clinics and PODs, or points of distribution.
    I wanted to take a minute to put in another ask, and that 
is simply that the public health system has been so underfunded 
for decades. In Colorado, we have a State Department of Public 
Health and Environment and then each county is served by a 
county local public health agency, 55 in all, and of course 
with this response we've all had to scale it massively. My 
department has a $600 million-a-year budget. We've been awarded 
$1.2 billion in this response that we will push out.
    But the problem is, if you can imagine having to scale up a 
workforce on the State and local level, trying to hire and 
onboard and train and get everybody an email address and 
coordinated during a pandemic is so hard. So we need to 
ongoingly support our public health system.
    Back to vaccines, though, Colorado now has more than 770 
providers to help distribute vaccines, and nearly 465,000 
people have been vaccinated. Because Coloradans age 70-plus 
account for 78 percent of deaths in Colorado, our goal is to 
vaccinate 70 percent of them by the end of February.
    Hospitals have carried much of the weight in getting this 
done. They have dazzling efficiency in reaching a high number 
of people quickly. But also, our local public health agencies 
have been coordinating the so-called last mile of distribution, 
helping determine where vaccine goes in their community, and 
setting up mass vaccination clinics or PODs.
    Long-term care facilities in Colorado, with the exception 
of about 20 rural facilities, are relying on the Pharmacy 
Partnership for Long-Term Care Program. We've largely overcome 
delays with that program in Colorado by providing staffing 
assistance.
    And then, finally, an important part of our vaccine 
distribution response is to make sure that no one is left 
behind. For example, we know people of color have been 
disproportionately impacted by COVID-19 in terms of number of 
cases, hospitalizations, and deaths. The pandemic has laid bare 
the societal disparities that have existed for generations but 
which COVID-19 has exploited.
    Knowing the challenge, the State has a goal of ensuring 
there is a community-based clinic providing vaccines in 50 
percent of the top 50 census tracts for high density, low-
income, and minority communities. We'll achieve this goal 
through our community-based health centers, local public health 
agencies, statewide pop-up clinics in collaboration with 
community-based organizations and churches.
    Coloradans are eager to get vaccinated, and we are eager to 
vaccinate everyone who wants to be vaccinated and end this 
crisis.
    Thank you for your time today, and I appreciate being able 
to come before you to testify.
    [The prepared statement of Ms. Ryan follows:]
    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
    
    Ms. DeGette. Thank you so much, Director.
    And now it's time for Members to have the opportunity to 
ask the panel questions. The Chair will now recognize herself 
for 5 minutes.
    So I would just like to start with you actually, Director 
Ryan. You said in your testimony--and this was echoed in 
several of our other panelists' testimony as well--that vaccine 
supply and predictability have been a challenge. How are those 
challenges impacting the vaccination efforts in Colorado, and 
what do you need from the Federal Government to improve the 
rate of vaccinations in our State?
    Ms. Ryan. Thank you for the question, Madam Chair. We 
simply need more supply. As I mentioned, we're getting about 
80,000 doses a week. We have the capacity for 300,000 doses now 
and are ramping up to 400,000 in the next month. So we need 
supply, and then we need better predictability in terms of the 
number of weekly doses we will be receiving to help with our 
planning efforts.
    Ms. DeGette. Yes. And, Dr. Khaldun, you also said in your 
testimony, in your written testimony, that Michigan's, quote, 
``single biggest challenge with the vaccine rollout has been 
the limited supply of vaccine available week to week and the 
lack of a national Federal strategy until now.''
    I'm wondering, Dr. Khaldun, how you expect the Biden 
administration's national COVID-19 strategy to impact 
vaccination efforts in your State.
    Dr. Khaldun. Yes. So I really appreciate the Biden 
administration's strategy. Last week, the State of Michigan 
actually updated our strategy that aligns with the Biden 
strategy, focused on getting shots in arms, building out a 
robust network, maximizing efficiency, personnel, and, of 
course, a mass communications effort.
    And so what I'm pleased by--and I've had several 
conversations with the Biden administration--they will be 
supporting us in our strategy. They will be supporting building 
out more of the public health workforce and supporting us with 
some of our efforts when it comes to equity, whether it be 
mobile clinics or supporting personnel that are getting out 
into communities.
    Ms. DeGette. Dr. Ezike, would you agree that the lack of a 
national Federal strategy until now has hamstrung the efforts 
in Illinois? And what's the top suggestion for how we can go 
forward?
    Dr. Ezike. Thank you for that question. I would say indeed 
it has. I think at the top of the list we could cite the 
confusing messages around the importance of masking. We need a 
focused, dedicated message that talks about the importance of 
masking. We know that there are other countries outside of ours 
that have controlled this virus even before a vaccine was in 
place. And so that attention and focus to masking, which I 
think I see that this administration absolutely puts at the top 
of its priorities, is very important and is one of the first 
steps, along with vaccination and promoting vaccination in all 
groups.
    Also remembering that vaccination, there are lots of 
vaccine-hesitant groups. And so, as we are in this period of 
still waiting for the supply to increase the demand, we want to 
also build that foundation, that community engagement for those 
who are vaccine-hesitant. And so we have seen the attention to 
that with this administration in the identification of an 
equity chair, a COVID equity chair, so that we can work on the 
vaccine hesitance as well so that we can bring all of us 
through this. We don't want to leave any group behind. And so, 
as much as rapidity is important, equity is important. Rapidity 
without equity will result in continued disparity.
    Ms. DeGette. Thank you. Thank you. I think those are 
important points.
    Dr. Phillips, you talked about the need for continuing 
flexibility and visibility when it comes to the doses allocated 
to the Federal long-term care pharmacy program. I wonder if you 
can just spend a few moments talking about that program and why 
flexibility is so important.
    Dr. Phillips. Absolutely. As we know, very early on, week 
by week we increased the number of doses that we were 
allocating to that program based on the methodology from our 
Federal partners. But we do know based on the rate of speed 
that they've administered the vaccine that doses have been left 
sitting there, waiting. So the speed of distribution is not 
keeping up with the speed of allotment that States have 
allotted to their partnership.
    And so utilizing the most recent clawback availability--so 
in recent weeks it's been announced that we're able to pull 
back some of that vaccine to match the actual administering 
rates. Doing so has allowed us to be able to push more in the 
community and not have vaccines sitting anywhere. And so that 
flexibility been greatly appreciated.
    Ms. DeGette. Thank you so much.
    And last but surely not least, because West Virginia's 
efforts are a national model, Dr. Marsh, can you just tell us 
how Congress and the Federal Government can facilitate better 
collaboration between the Federal and State experts and how 
that would benefit your vaccination efforts for your State?
    Dr. Marsh. Thank you, Madam Chair. Certainly, as the other 
experts have testified, that having more vaccine is very 
important for us as well. We get about 23,600 doses a week. 
Without expanding our infrastructure, we could handle about 
125,000 doses a week. And we believe with a small increase in 
our infrastructure, it could go over 200,000 doses a week. So 
dosing is really important.
    But I think also there's a really terrific opportunity for 
us to make sure that we're sharing our best practices and 
sharing our learnings, and right now I don't think that there 
is an integrated portal or pathway to allow each of the leaders 
of the States, along with the leaders of the Federal Government 
response and perhaps the coronavirus task force experts, to be 
able to come together to be able to freely and quickly exchange 
information so that we can all undergo this rapid cycled 
learning opportunity and also learn the things that don't work, 
because it's just as important not to keep doing the things 
that don't work as well as trying to adopt the things that do.
    Ms. DeGette. Excellent suggestions. Thank you so much. My 
time's expired.
    And I know now that the chair--or the ranking member of the 
full committee, Mrs. Rodgers, is going to go next.
    And so you are recognized for 5 minutes.
    Mrs. Rodgers. Thank you, Madam Chair.
    And thank you all who have joined us as witnesses today. We 
thank you for your leadership, your commitment to the health of 
all in our communities. This is at a time when we need hope and 
healing in our country, and you're on the front lines. So thank 
you so much.
    My first question is, it's a simple yes or no to all of our 
witnesses. I just wanted to ask: At the start of this pandemic, 
did any of you anticipate a safe and effective COVID-19 vaccine 
to distribute and administer only 10 months later?
    Dr. Marsh. No.
    Ms. Ryan. No.
    Dr. Ezike. No.
    Dr. Phillips. No.
    Mrs. Rodgers. Thank you.
    Next question to everyone: Has a vaccine distribution of 
this magnitude and complexity ever been attempted before in the 
United States?
    Dr. Marsh. No.
    Ms. Ryan. No.
    Dr. Ezike. No.
    Dr. Phillips. No.
    Dr. Khaldun. No.
    Mrs. Rodgers. Thank you.
    I wanted to ask Dr. Marsh also--and I think the last person 
was just talking about the importance of best practices and 
learning from the other States, which I think is part of the 
goal today.
    And I just wanted, Dr. Marsh, if you would just speak to 
what you believe has been important in West Virginia as we 
anticipate this, the challenges with the vaccine distribution, 
but a pandemic this large. I just wanted to ask you to speak to 
the importance of a localized approach to the response, because 
we've heard from so many about a Federal approach.
    And I know, in Washington State, you know, I've been 
frustrated with a one-size-fits-all approach, not even taking 
into consideration as much my region or, you know, we've had 
the same responses and restrictions across the State regardless 
of the facts on the ground. And my Governor, Governor Inslee, 
has continued to say, ``Well, we need more Federal 
involvement.''
    I just wanted you to speak to the importance of a more 
State-by-State approach.
    Dr. Marsh. Thank you, Ranking Member Rodgers. Well said. 
It's a pleasure to talk about our approach.
    And I think that, you know, West Virginia, as a small 
State, 1.7 million people, that is very rural, largest city is 
50,000, and as we start to look at our own needs in our State, 
we see that we have a very distributed location set of where 
people are in the State.
    So we believe that, in order to best meet the needs of our 
citizens, we need to have local involvement at many levels, 
that we can share information, same way that we've talked about 
here, because, as this is so complex and there are so many 
issues that you need to deal with, that you can't really 
predict the future, you have to be able to become agile and 
respond.
    And we're scrappy and resilient, and we have created our 
own supply chain for things. We have partnered local pharmacies 
with the places we want to vaccinate. We are controlling the 
supply chain of our vaccine. We believe pharmacists should be 
in charge of the vaccine because of the critical nature and 
difficulties in storing and transporting some of this.
    But, to me, without absolutely casting any aspersions on 
anybody else, we are creating the solutions that work for West 
Virginia, and we are all committed to serving our citizens. And 
I think that that----
    Mrs. Rodgers. Thank you.
    I have one more question I want to get to all the 
witnesses. And I just wanted each of you to speak briefly 
about, what did CDC do to assist you in developing and 
exercising your plan before the vaccine was actually delivered 
to your State?
    Maybe I'll start with Dr. Marsh since I cut him off, and 
then I'll go with the others. If you could just speak very 
quickly.
    Dr. Marsh. Yes. Quickly.
    We've had a lot of conversations with CDC, but we created 
our own program.
    Mrs. Rodgers. OK. Thank you.
    Colorado?
    Ms. Ryan. Yes. We coordinated with CDC around creating our 
original plan in October.
    Mrs. Rodgers. Very good.
    Illinois?
    Dr. Ezike. Yes. We did have multiple CDC, FEMA, HHS 
interagency meetings for our region to discuss our plans and 
hear of other States in our region to hear their plans as well.
    Mrs. Rodgers. Thank you.
    And who am I missing here? I'm sorry. Michigan.
    Dr. Khaldun. Yes. We also had several meetings with the CDC 
and other Federal partners. We also worked very closely with 
our local health departments. We have over 45 local health 
departments across our very vast State, urban and rural 
populations. We worked very closely with them as well on our 
plans too.
    Mrs. Rodgers. Very good. Thank you all again so much. This 
has been a tough, tough year, to say the least.
    Ms. DeGette. Thank you so much.
    The Chair will now recognize the chairman of the full 
committee, Mr. Pallone, for 5 minutes.
    Mr. Pallone. Thank you, Madam Chairwoman.
    I think I'm going to have to start out by saying that I 
definitely disagree with what our Ranking Member Rodgers said 
with regard to not having--you know, looking at this State by 
State or localizing it versus having more Federal involvement. 
I mean, I didn't--I have to take your word for what Governor 
Inslee said, but I think I agree with him that we need more 
Federal involvement.
    I mean, part of the problem that I saw in the last 9 months 
under Trump was that States were essentially left alone, and 
they were competing with each other for gloves and masks and 
supplies and sometimes being gouged with prices.
    And I do think, and I've said all along, that we need a 
national strategy, which is what Biden is trying to accomplish. 
So I understand this one-size-fits-all, but I don't think that 
that necessarily works when you have a pandemic of this 
magnitude.
    Now, that isn't to suggest that this isn't a Federal system 
where there is a national strategy and we still try to 
implement this, the response, State by State. But the fact that 
President Trump so much stressed that States were on their own 
and there wasn't a need for a national strategy, I think, was a 
huge mistake, and I think it was an ideological approach that 
led to the fact that we didn't have an effective response under 
the Trump administration. But, you know, whatever. That's my 
spiel.
    Let me ask this question. Let me go to Dr. Khaldun.
    What's happening now, of course, is Biden implemented a 
three-prong strategy last week, or started a strategy, where he 
said that we're going to give you notice 3 weeks in advance so 
you know what's coming. That's the transparency. He increased 
the number of vaccines that were coming weekly to the States. 
And then he set out a plan to actually vaccinate 300 million 
Americans beginning in the summer and certainly by the fall.
    So I wanted to hear--I wanted to ask for your response to 
that, how that's going, and what you think about it.
    And then, secondly, we have a bill. In other words, we have 
this bill, the American Rescue Plan, that we're going to try to 
do in the next few weeks that provides a lot more money for 
vaccines, for testing. And my understanding at the State level 
is that the States are still wanting with resources and need 
that additional money and need it soon, because many of them--
you know, we didn't provide any State and local aid in general 
directly, and many of them are still using their own money and 
need Federal help.
    So those are the two questions. One's what about what 
happened with that three-prong Biden plan, and whether we need 
another COVID bill because you're lacking resources.
    Dr. Khaldun. Thank you, Chairman, for that question.
    So I have been very appreciative, actually, of the Biden 
administration, had several conversations with leadership.
    We do for the first time have at least--have 3 weeks of 
transparency as far as how much vaccine will be getting into 
the State. That's very helpful, because now I can tell my 
providers that they get a certain amount of vaccine, and they 
can go ahead and schedule. So it's been incredibly helpful.
    We also are very thrilled that potentially the American 
Rescue Plan will go through. We certainly need additional 
funding.
    Right now, I'm at a point where I have contact tracers that 
are getting involved in my vaccination efforts. I have 
epidemiologists who work on lead and other things in the health 
department who are now being pulled into vaccine efforts. We 
absolutely need more funding to build our infrastructure, to 
bring in more staff to be able to support our vaccination 
efforts.
    Mr. Pallone. And then there is about a minute left. If I 
could ask the Colorado representative, Ms. Ryan, the same two 
questions about the last three-pronged Biden announcement and 
the need for another--more resources through another 
legislative--through another bill that we're planning.
    Ms. Ryan. Thank you for the question.
    I will say that the transparency and predictability is 
improving, as are the number of doses. We know those are slowly 
going to be increasing over the month of February.
    Yes, we could absolutely use more Federal help. We are 
seeing the same things with our local public health agencies 
trying to decide do they put their staff as vaccinators or 
contact tracers, still lacking the resources, and pulling all 
the staff they have off of all their other duties as they've 
done all along.
    So I think it speaks to the need for sustainable funding in 
addition to emergency funding. And we did just get some funds 
from the CDC and a new ELC grant and other funding, and we will 
be putting that to good use. But we anticipate, you know, this 
response is going to be with us for a long time, COVID is not 
going away, and we're going to need sustained dollars.
    Mr. Pallone. Thank you.
    Thank you, Chairwoman DeGette.
    Ms. DeGette. Thank you, Mr. Chairman.
    The Chair now recognizes the ranking member of the 
subcommittee, Mr. Griffith, for 5 minutes.
    Mr. Griffith. Thank you very much, Madam Chair.
    Dr. Marsh, if I remember your comments earlier, that you 
all did not go with the Federal plan but created your own plan 
to suit West Virginia needs. Is that correct?
    Dr. Marsh. Yes, that's correct.
    Mr. Griffith. All right, I appreciate that, because I think 
sometimes it's nice to have a Federal template, but some States 
need that ability to do what you all did in West Virginia.
    Now, going on to the next question. Since distribution of 
COVID-19 vaccines--and I'm with you still, Dr. Marsh--since the 
distribution of COVID-19 vaccines started in December, there 
has been confusion as to why there is such a discrepancy 
between the number of doses distributed as compared to the 
number of doses administered by the States. For example, the 
CDC website notes that, as of January 31st, over 49.9 million 
doses have been distributed, but only 31.1 doses have been 
administered.
    Can you explain the reason, if you know, for this 
discrepancy in doses distributed versus doses administered?
    Dr. Marsh. Well, thank you for the question.
    Certainly in West Virginia, by working to have local 
control of the doses, we've followed every dose and understand 
that. Certainly other States have adopted different strategies, 
and there are a significant, as I understand it, number of 
doses that are not accounted for in the current system. And 
whether those are some of the doses that have gone into various 
programs, like the Federal pharmacy program or others, I don't 
know off the top of my head, but certainly maintaining control 
and understanding where the doses are, are a critical component 
of success, I believe.
    Mr. Griffith. You raised that you all track them. How do 
you all track the vaccine, where it's been sent and how it's 
being used, and how quickly it's being used?
    Dr. Marsh. We receive every dose into one of five hubs that 
are located around our State to bisect the State so that the 
shortest distance is required to move vaccine between places. 
We track each dose that's sent with a GPS tracker, and we then 
have an inventory. We know, if the vaccine is not administered 
in 7 days, then the vaccine is brought back into the central 
hub and reallocated.
    Mr. Griffith. Thank you.
    I mentioned the CDC website a few minutes ago. In addition, 
that website shows a map of the U.S. with COVID-19 vaccine 
administration data for each State and territory, including the 
total doses administered per hundred thousand. The States and 
territories range in their rate of total doses administered 
from 38,000--excuse me--3,826 per hundred thousand in the 
Federated States of Micronesia to 16,348 per hundred thousand 
in Alaska.
    Since the Federal Government and its partners in the 
private sector have used the same process to ship vaccine doses 
to all of the States and territories in the U.S., what do you 
believe accounts for the variation among the States in what 
some have deemed the last mile in the vaccination 
administration efforts?
    Dr. Marsh. Are you asking me again?
    Mr. Griffith. Yes. Yes, sir. I'm sorry.
    Dr. Marsh. Yes. So I think that, as we go forward, you 
know, it's--it is easy to point fingers, but, as was said 
earlier, this is the most complex program and distribution plan 
that we've ever experienced in our country. And certainly 
having vaccine is amazing, and we have amazing vaccine, so 
that's great.
    And I think that, you know, for us, it's really a matter of 
all of us working together to get the right priorities, to 
follow the doses, and make sure that every American who needs 
to have a vaccine in their arm in a priority status gets that 
vaccine.
    Mr. Griffith. Well, I appreciate that. And that's part of 
the reason that Madam Chair DeGette called this meeting.
    Clearly there has been confusion about the safety and the 
efficacy of the shot and in some States confusion about the 
who-what-when-where details of getting the shot.
    What methods of communication are you using--and we'll 
start with you, Dr. Marsh, and we'll see how much time we have 
to get to the others--but what methods--hang on. I don't have 
my eyeglasses on, and I lost track.
    What methods of communication are you using to provide this 
critical information to get the information to constituents? 
And, as a part of that, specifically how have you made an 
effort to reach seniors and other hard-to-reach populations, 
many in my district, not unlike West Virginia, who do not have 
reliable access to the internet?
    And, also, in December the FCC made an allowance for State 
government officials to reach constituents on their mobile 
phone for relaying critical information, and have any of your 
States used that technology?
    So what are you all doing to reach out to folks who may not 
be aware that they're on the list to get the shot now?
    Dr. Marsh. Very briefly, we have internet. We have 
television briefings three times a week. We have a call center. 
And we have reached out on different community-based approaches 
to reach all the vulnerable people in our communities that 
have--that should have access to vaccine.
    Mr. Griffith. And I appreciate that. And I will tell you, I 
get a mobile notification whenever schools are closed back 
home, and the government there is using it for that. I would 
think that would be a good technology for this as well.
    I don't have time for everybody else to jump in, but if you 
all could provide a written response to that last question 
about what kind of technology you're reaching out to these 
communities that may not be getting the word and who may be a 
little bit hesitant, I would greatly appreciate it.
    And, with that, I yield back. Thank you for your patience, 
Madam Chair.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes the gentlelady from New Hampshire, 
Ms. Kuster, for 5 minutes.
    You need to unmute, Annie. Unmute.
    Ms. Kuster. That's what I'm doing. Sorry. Trying to unmute.
    Thank you very much, Madam Chair.
    Well, it's taken a Herculean effort to get COVID-19 
vaccines developed, authorized, and distributed around the 
country. As you've heard today, it will be for naught if we 
can't get the vaccines into the arms quickly. And that's why 
I'm concerned by the CDC data showing, as of yesterday, only 
about 65 percent of vaccines distributed have actually been 
administered.
    And so I wanted to jump in to legislation that I've 
introduced to bolster manufacturing capacity and meet the 
challenge, known as the Coronavirus Vaccine and Therapeutic 
Development Act, to ensure that enough doses get in the arms of 
the American people.
    The issue of supply does not account for this large gap in 
doses allocated but not administered. And I understand there 
may be reporting delays and data challenges. But thousands of 
Americans are dying every day, and I believe it's unacceptable 
to delay getting the vaccine.
    Dr. Phillips, according to CDC data, Louisiana has 
administered about 71 percent of the data. Can you confirm, is 
Louisiana still holding back vaccine for second doses?
    Dr. Phillips. Yes. We do make sure we allot the second 
doses wherever the first doses went to ensure that we have 
adequate supply for when those individuals present.
    I will say that, in terms of the CDC data, it does include 
the first and second doses. So when you look at what has been 
allocated for a State, it's combining that first and second 
dose.
    So, although I may have received my first dose and my 
second dose may have been shipped to the State, it may not be 
my 21- to 28-day timeframe. And so it does give the appearance 
that an available dose can be administered as a first dose when 
truly that is not the case. So I do think that is one of the 
asks that we have, for some clarification on the CDC data for 
stratification for those modules.
    Ms. Kuster. But how do you feel about the change in 
direction that the Biden administration is considering due to 
the urgency and due to the various COVID variants that are 
coming along with getting the doses into the arms immediately, 
knowing that we will have sufficient vaccine for those second 
doses?
    Dr. Phillips. Yes. Until we know for sure that we're going 
to have sufficient vaccine for those second doses, that would 
be a worry.
    And so, again, this is our first time being able to even 
get advanced notice, 3 weeks advanced notice of what our 
allotment is going to be. Until that is confirmed and can be 
substantiated for some time, that would be a worry in terms of 
availability of the supply.
    Ms. Kuster. Dr. Ezike, could you respond to the similar 
question?
    Dr. Ezike. Yes, ma'am.
    Ms. Kuster. Would you consider giving those second doses 
now as first doses knowing that the remaining second doses 
would be manufactured and distributed within the 3-to-4-week 
timeframe?
    Dr. Ezike. Yes, we are understanding the very difficult and 
delicate balance between getting ahead of the variants and 
getting ahead of this virus as well as ensuring that we will 
have the vaccine 3 to 4 weeks later.
    We are--that is the reason that we were able to take 
advantage of the ability to take doses--borrow doses from the 
long-term care facility and not at all interrupting the 
vaccination that would happen in the next 3 to 4 weeks, but 
borrowing from there to get more doses in the arms today.
    We do know that two doses are required for full efficacy, 
as demonstrated in the trials, but even getting that first dose 
we know offers some protection, confers some protection, and so 
getting as many first doses as well.
    So we have been striking this balance between promoting the 
first doses as well as the second doses, and we want to use as 
many available doses as quickly and effectively as possible.
    Ms. Kuster. Dr. Khaldun, maybe you could jump in here. How 
will increased transparency and improved data make sure that we 
can quickly administer the doses that are available?
    Dr. Khaldun. That's very important. Again, I speak to my 
local health departments and our healthcare systems frequently. 
Knowing ahead of time how much they can expect to receive will 
be incredibly helpful. It will actually make it go quicker, 
because they can schedule appointments. They can know they 
don't have to cancel appointments and they'll be able to plan 
for those first and second doses.
    So that transparency and knowing ahead of time how many 
doses entities will receive is incredibly important.
    Ms. Kuster. Thank you.
    My time is just about up, but I'll put in a plug for my 
bipartisan bill with Congressman Bucshon on this committee, the 
Immunization Infrastructure Modernization Act, to provide 
Federal support and guidance to the healthcare departments and 
providers at the State and local levels and, most importantly, 
to improve our healthcare information framework.
    Thank you very much. I yield back.
    Ms. DeGette. Gentlelady yields back.
    The Chair now recognizes the gentleman from Texas, Mr. 
Burgess, for 5 minutes.
    Mr. Burgess. I thank the chair.
    You know, it's interesting to me that, just a little less 
than a year ago, we had a committee briefing--we didn't have 
hearings on this in a timely way, but we did have a briefing. 
All of the experts of public health were at that briefing, 
names that you would recognize. And Dr. Fauci was asked, ``How 
long before we can get a vaccine?''
    And he said, ``Listen, if everything goes perfectly, 18 
months. But I must caution you, everything never goes 
perfectly.''
    Now, I don't believe Dr. Fauci was misleading us a year 
ago. I think he was speaking as to the way the world was a year 
ago. But this became a priority, and the previous 
administration appropriately recognized that priority and began 
what we now know as Operation Warp Speed.
    And, realistically, this vaccine was available--the 
emergency use authorization came right at the middle of 
December. So we're just talking 6 weeks ago.
    Now, prior to the time, during September and October, 
various talking heads on the various television shows would 
talk about how the vaccine--it was not possible to deliver the 
vaccine in that timeframe. In fact, people were talking against 
accepting the vaccine because it's being developed so fast, it 
can't possibly be any good, or there may be problems.
    And now there has been a massive shift of gears because, 
good news, 2 weeks after election day, there was not one, but 
two vaccines that were on their way to the FDA. And then, a 
month later, the FDA--which truly was lightning speed for them, 
provided the emergency use authorizations to bring us to the 
discussion today of, how can we do a better job about 
distribution?
    But I would remind you that a year ago we were told that 
that distribution problem would still be 6 months in the 
future. So, really, we have to be grateful for where we are 
today.
    My home State of Texas, the most recent data I received--
and I will submit this, Madam Chair, for the record--but 
there's about 2 million doses have been administered in Texas. 
Now, I recognize we're a big State, we've got a lot of people, 
and we've got a long way to go, but that is a good start.
    In fact, I participated with several of my State 
counterparts to encourage the creation of a vaccine hub in one 
of my counties, Denton County, and this replicated a hub, a 
vaccine hub, that was actually started in 2009 with the H1N1 
epidemic, and it is now up and functioning. And, in fact, 
32,000 doses allocated for Denton County this week, and they 
are setting up a drive-thru vaccination site in the parking lot 
of Texas Motor Speedway because, after all, that is one of the 
biggest locations where you have a big parking lot, one of the 
biggest in the country, so they're well set up to do that.
    But how grateful we should be to be able to have not just 
the vaccine, but now, within such a short period of time, that 
level of distribution.
    Several of the witnesses testified that they had worked 
with CDC. And, again, I need to stress this, because the 
approach in the previous administration was, yes, let's work on 
the vaccine, but let's also work on the manufacture of said 
vaccine even in advance of the emergency use authorization of 
the FDA. And the CDC was working with some local health 
departments to formulate the plans for administration of the 
vaccine when it did become available.
    So I think those things were forward leaning and, in fact, 
if I recall correctly, quite different from the activity we saw 
in 2009 where the manufacture of the vaccine did not begin 
until the FDA had, in fact, issued its approval.
    So we are several steps ahead of where we could be. That 
doesn't mean we're doing good enough. And I appreciate so much 
everyone on this panel who is working so hard to make certain 
that we do get the amount of vaccine out in the right amount of 
time.
    Now, let me just ask--and I'd like to ask Doctor--Director 
Ryan from Colorado. I worked with your Governor when he was 
here at the House of Representatives on the House Rules 
Committee. My best to your Governor when you see him again. But 
how do you feel that you're doing with the visibility of the 
vaccine doses that are going to be coming your way? Are you 
hearing about it in a timely fashion?
    Ms. Ryan. Thank you for the question.
    The transparency is getting better. I think, you know, part 
of the issue is that, because it's going from conveyor belt to 
States, there is just not a lot of time to tell us the type of 
doses or the amount of doses that we're getting. But we know 
it's--we do have visibility into the next 2 or 3 weeks now.
    Mr. Burgess. And that's great.
    And, Madam Chair, just if you'll indulge me for one second. 
A little bit of good news, reading in Barron's just the other 
day where Sanofi was going to begin to manufacture the Pfizer 
product to assist in getting doses out. Sanofi's own exercise 
with getting a vaccine was a bit delayed, and so they are 
joining the manufacturing side of a competitor's vaccine. And 
that's good news too. That's the type of cooperation we're 
seeing out there in industry, and I think that's important, and 
I believe it will continue.
    And I'll yield back.
    Ms. DeGette. I thank the gentleman.
    The Chair now recognizes the gentlelady from New York, Miss 
Rice, for 5 minutes.
    Miss Rice. Thank you, Madam Chairwoman.
    Much of the confusion surrounding the rollout of COVID-19 
vaccine seems to be driven--and I'm hearing this throughout 
this hearing--by poor communication. And we know that that, in 
the final weeks of the Trump administration, that was 
particularly acute.
    And obviously what I'm hearing--what all of us are hearing 
here today--is how important that communication is between 
Federal, State, and local health officials. In fact, GAO has 
repeatedly noted that coordination and communication are 
critical to the successful implementation of COVID-19 vaccines.
    So to you, Director Ryan. In the past your Governor has 
been critical of the Trump administration's lack of 
communication and maybe miscommunication with Colorado, 
particularly in the first months that the vaccines were being 
shipped to the States. How would you describe the communication 
and coordination that Colorado has had with Federal officials 
related to vaccine program planning and implementation in 
recent weeks, and have you found it to be more effective, less 
effective? How would you rate it?
    Ms. Ryan. Thank you for the question.
    I have to tell you, you know, General Perna, who has been 
the tip of the spear for the vaccine distribution, has been 
very supportive from the start. He got on a call with States. 
He called me personally and said, ``Here is my number. You tell 
me if things aren't going well.''
    So, while I, you know, do have a list of complaints from 
the last year around communication issues, I have to tell you 
that was the first time that I felt like I had someone in 
charge that I could go to and that was keeping us updated, and 
there was a lot of transparency.
    So I can't say--I can't complain too much about the vaccine 
rollout and our communication with the general and Operation 
Warp Speed. I actually think that's gone pretty well, and, as 
they've gotten more visibility, they've given it to us.
    Miss Rice. Great.
    Dr. Phillips, would you agree? Is there more that can be 
done to improve communication between the Federal Government 
and the States at this critical time of vaccine distribution?
    Dr. Phillips. I think ongoing continued communication is 
what we need. I mean, I think you've heard it from everybody in 
the hearing today and other States who are not present, is what 
we've been asking for, and I think we're continuing to see that 
increase, and we're thankful for that.
    That allows us to be able to communicate with our local 
partners, our local providers, who are asking for the same 
information so, when we get it, we're able to share with them. 
And if we have to do it with a caveat that this is a draft, 
this is the model of it, then we can put those caveats on it. 
But the more information we have on the front end, the better 
we are in terms of the planning purposes.
    Miss Rice. So, you know, we've heard that many cities and 
local health departments have been left in the dark by both 
Federal and State officials when it comes to distribution of 
vaccination plans, relying instead on local hospitals or 
providers to confirm if vaccines are available in their 
community. I know in New York State, where I'm from, there have 
been people who it takes forever for them to get an 
appointment, and then, you know, a week or sometimes days 
before, their appointments are canceled because of this lack of 
communication about how many vaccines were available, when 
they're going to arrive, et cetera.
    Dr. Ezike, what is your State doing to communicate with 
local leaders and public health agencies? And is there room for 
greater coordination across all levels of government? And, if 
so, what would you recommend?
    Dr. Ezike. Yes. Thank you for that question.
    Of course, collaboration and communication against all 
levels of government, from Federal to State to local health 
departments, is key to overcoming this pandemic. You know, 
between the State and the local health departments, we 
understand that those local health departments are literally 
our hands and feet. They, the 97 different local health 
departments, are actually the boots on the ground that are 
getting this work done as we support them with the funds that 
are provided and the additional State resources that we may 
have.
    So communication--and overcommunication, if there even is 
such a thing--is the name of the game, and their success is 
directly tied to how much they understand about their future 
allocations. We have a rule at the State that anything that we 
are doing in their State, whether if we are directly supporting 
their efforts or trying to do additional efforts to augment 
their existing efforts, that we have to let them know.
    If we're coming into your backyard, we're going to let you 
know so that you can make sure you direct us in the best way 
that it can be done. We want that same kind of partnership and 
collaboration, we want to be at the table as decisions are 
being made, so that we can help inform things that might not be 
top of mind.
    I am actually very encouraged with the current 
administration, as they have actually taken one of the State 
health officers to be a part of the administration, and I think 
that will help establish the importance and the communication 
between the State health officials as well as with the Feds, 
which in turn creates better communication. We have 
appropriate, accurate, timely information to share to our boots 
on the ground, our local health departments.
    Miss Rice. Thank you, Dr. Ezike.
    And, Madam Chairwoman, I see that my time is up. I had one 
more question, but I will yield back. Thank you.
    Ms. DeGette. I thank the gentlelady.
    The Chair is now pleased to recognize the gentleman from 
West Virginia, Mr. McKinley, for 5 minutes.
    Mr. McKinley. There we go. Thank you, Madam Chair.
    Look, we've heard a lot of criticism today of the Trump 
strategy, but I want to remind people that on September 16th 
the States were given a 57-page guidance document--57 pages in 
how to set up a program--and they were asked to respond by 
October the 16th, just a month later. So for people to say 
there are no plans, that just means the States didn't create 
one that works.
    So, for those of you that can't resist the temptation to 
criticize the former administration and even going so far as to 
say that the Biden administration was starting from scratch and 
there was no national strategy, Dr. Fauci has refuted that very 
clearly. So take a deep breath.
    Look, Operation Warp Speed created the vaccine. The State, 
it's the job of the States to put it in people's arms. But it 
seems that States can't even get that right.
    Here is a chart, unfortunately, that the majority party had 
rules that we had to submit this 24 hours prior to this, but 
this chart indicates that there were some States that can't get 
it right. Some of you, some States have been complaining they 
need more vaccines, but have only given out more than 50 
percent.
    Look at Illinois. Illinois' vaccination rate is half of 
what it is in Alaska at 8.3 people per hundred. But Alaska is 
16.8. Or West Virginia is almost 15 per 100, and Illinois, 8; 
Colorado, 10; Michigan, 10.
    But then they don't--they're not using it. Their use of the 
vaccine in Illinois is only 62 percent as compared to North 
Dakota, 91 percent.
    So apparently they didn't develop a plan that it was 
flexible enough to work. So I'm just concerned about that.
    Now, unlike New York--and that's a key thing--unlike New 
York's Governor, who ignored the vulnerable in their long-term 
facility and recommendations of his public health experts, West 
Virginia prioritized its long-term care residents and their 
staff. West Virginia also finished vaccinating all of their 
long-term care facility and staff. Meanwhile, States like 
Michigan won't even--won't finish until the end of this month.
    So, interestingly enough, no one has given--and no one 
really, I think, has given proper attention to Operation Warp 
Speed.
    Remember, Dr. Fauci testified before the Senate committee 
in May of last year that it would take a year to 18 months 
before a vaccine could be developed--think about that--a year 
to 18 months in May that, through the hard work of the 
pharmaceutical companies, researchers, and scientists, a 
vaccine was available in December, just 7 months later. So just 
7 months after the creation of Warp Speed we had a vaccine.
    So I guess what I want you all to take away is complaining 
about not getting enough vaccine is like complaining about the 
size of your meal when you should be grateful to having food on 
the table.
    So, Dr. Marsh, I'd like to turn to you, and just in the 
remaining time that we have here can you expound just a little 
bit more about what was the magic in West Virginia, being not 
only at a rate of 15 per hundred vaccination rate, but also at 
almost 87, 88 percent used of the vaccine? What can we say to 
the other States how they can improve on that?
    Dr. Marsh. Well, thank you, Congressman.
    Ultimately, West Virginia made a plan that worked for us, 
and it was really a matter--and we've talked about this at this 
testimony--it's a matter of clear communication, breaking down 
parallelisms and sectors. Everybody wore the same hat. We were 
operating for a higher purpose. And, as we go forward, we 
constantly iterated and are iterating our approach so that we 
are moving in a most expeditious and quick way possible.
    I just want to reinforce one thing that the Congressman 
said as well, and I say this in as an apolitical way as I can. 
The fact that we have these vaccines are game changers. This is 
the most complex, you know, problematic response probably in 
the history of modern-day America and the world. And so staying 
together and working together and sharing with each other best 
practices is really key for our global and country's success.
    Thank you.
    Mr. McKinley. Thank you. I yield back.
    Ms. DeGette. The gentleman yields back.
    The gentleman from New York, Mr. Tonko, is recognized for 5 
minutes.
    Mr. Tonko. Thank you, Madam Chair. Can you hear me?
    Ms. DeGette. We can hear you, sir.
    Mr. Tonko. OK. Thank you so much.
    Since the start of the vaccine rollout, the challenges and 
issues facing State and local health departments have been 
endless. Whether it's a lack of transparency in how much 
vaccine will be allocated to States each week, shifting 
guidance on who to prioritize for vaccinations, questions about 
vaccine reserves, or just a simple lack of vaccines, it seems 
there has been one constant throughout this process--that being 
confusion.
    Dr. Phillips, in my district in upstate New York we are 
currently seeing more COVID infection cases than we've had at 
any time during the pandemic, and the rate of spread is faster 
than the rate of vaccinations. At the current rate, it will 
take New York State roughly 7 months to vaccinate all eligible 
individuals in its phase 1 priority group.
    My question to you, is your State facing similar concerns? 
And, if so, how can we get more people vaccinated more quickly?
    Dr. Phillips. Thank you for that question, sir.
    Yes, we do see the rate in terms of the vaccine and the 
extended time period and the worries around that. One of the 
things that we are doing is looking at the available doses, 
first doses that are in the long-term care partnership, and 
pulling those back to push into the community so we have an 
increased availability in the community, in addition to the 
increase announcement that was made last week for vaccine 
doses.
    But that is going to be a big help to our State, being able 
to pull some of that back and utilize it immediately so it's 
not sitting there.
    Mr. Tonko. Thank you.
    Dr. Marsh, one of the main concerns we've heard from States 
is the need for greater transparency from the Federal 
Government into the vaccine supply chain. Now, I heard your 
talk of coordination and communication, but the Biden 
administration has taken a crucial first step in promising a 3-
week allocation forecast. But transparency alone will not get 
shots in the arms.
    So, Dr. Marsh, aside from increased supply and greater 
transparency, what would you change to make this process run 
more smoothly?
    Dr. Marsh. Well, thank you for that question, Congressman.
    You know, certainly we are very grateful to the 
administration before and this administration for their work to 
move vaccines in a more rapid way, to produce more 
vaccinations.
    A question was asked earlier, which I think is a critical 
question for our country, if we could be guaranteed that we 
will see more vaccines in the future. Emerging data is 
suggesting that a single dose of Pfizer, Moderna, and 
apparently Johnson & Johnson may have a significant protective 
effect on severe illness and death from COVID-19.
    So ultimately we would like to move forward in immunizing 
first doses in as many Americans and as many West Virginians as 
we can, as FDA and CDC have recommended, that we want to make 
sure that that supply is there for the second doses, even if 
they're a little bit later than the 21 days for Pfizer and the 
28 days for Moderna.
    And so I think that a strategy once we see sufficient 
supply chain will be to get as many vaccines in the arms--first 
vaccines in the arms--as we can, because we are racing with the 
variant forms of the virus that look like that they're going to 
have a lot more problems for the immediate future coming up.
    Mr. Tonko. Thank you, Doctor.
    In the capital region of New York, like many places across 
the country, the number-one challenge is a consistent, adequate 
supply of vaccine. The Biden administration is increasing 
weekly supply by 16 percent and has purchased enough vaccine to 
ensure 300 million Americans could be vaccinated by the end of 
the summer.
    Dr. Khaldun, in your testimony you state that Michigan has 
the short-term goal of administering 50,000 shots a day but 
could be administering up to 80,000 vaccinations per day. So my 
question is, will the 16 percent increase in supply be enough 
to meet that $80,000--excuse me--80,000-count-a-day projection?
    Dr. Khaldun. Yes. Thank you for that question.
    So we certainty appreciate the increase in the supply 
that's coming into the State. It will absolutely help us to 
meet our goals. Actually, our data on our website over the past 
couple of days, we've actually had about 50,000 shots in arms 
per day, so we are really pleased with that.
    What that increase also does, though, is help us to really 
target and focus based on equity. We are actually--we have a 
pot off the top that we take and target towards areas that have 
a higher Social Vulnerability Index so we can really make sure 
minority populations and those who are living in poverty have 
access to the vaccines, so when we have more, we are more 
easily able to allocate based on that.
    Mr. Tonko. Thank you.
    Madam Chair, I see that my time has run down, and I yield 
back.
    Ms. DeGette. OK. I thank the gentleman for yielding.
    The Chair now recognizes and welcomes Mr. Dunn to the 
committee for 5 minutes.
    Mr. Dunn. Thank you very much, Madam Chair. It's an honor 
to be here. And I appreciate the opportunity to evaluate the 
solutions and ideas to improve vaccine distribution at the 
State level.
    I think we're all acutely aware of the challenges 
accompanying distribution of these vaccinations. It's important 
to acknowledge that each State faces a set of challenges that 
are unique to its characteristics and demographics, and that 
requires flexibility and creativity to approach that, not one 
size fits all. The needs of Florida are not the same as the 
needs of Illinois, for example.
    I also want to echo the panel's comments that Operation 
Warp Speed produced effective vaccine in record time, and 
volumes of those vaccines at a speed logarithmically faster 
than ever in history. In fact, the entire universe of virology 
research and treatment has experienced a quantum leap forward.
    We just this last day or two reached an important milestone 
where we have now vaccinated with at least one shot of the 
series more people in America than have been tested positive 
since the beginning of the pandemic.
    And, with that, I'm going to turn to my questions.
    Dr. Marsh, I will try to be brief with my questions. I 
encourage you to do the same with your answers.
    Do you believe that public-private partnerships allow 
States to use their own resources more effectively than might 
have been possible with a far-reaching Federal mandate?
    Dr. Marsh. Thank you, Congressman.
    I do believe that these types of relationships could be 
very useful. I think that the optimal circumstance is a top-
down meets a bottoms-up approach related to shared governance 
in this way.
    Mr. Dunn. Thank you. So do you believe, in general, that 
there are areas where private industry can meet the needs of a 
State better than the Federal Government?
    Dr. Marsh. Is that to me again, Congressman?
    Mr. Dunn. Yes, sir. Yes, sir.
    Dr. Marsh. Yes. Certainly I think that there are 
circumstances where private partnerships can meet the needs of 
a State in unique ways.
    Mr. Dunn. Excellent. So what is your assessment of the 
Federal vaccination reporting requirements and infrastructure 
currently in place for States to relay information to CDC? Is 
it good, bad, or adequate?
    Dr. Marsh. I think that, as all of the responses, this is 
an evolving issue. I think that it is improving and probably 
needs to continue to improve to make it easier on the States to 
be able to report more easily.
    Mr. Dunn. I was impressed that you got your community 
pharmacists on board so quickly with the infrastructure. That 
says real planning on your part. Congratulations.
    Do you believe that all the shots that have been put in 
arms of the people in West Virginia or nationally--opine on 
either--do you think that all of those shots have been properly 
recorded and submitted to the CDC?
    Dr. Marsh. Thank you again for your question.
    I don't know the answer to that. Certainly I hope that we 
have an accurate reporting system, because documenting and 
following each dose of vaccine is critical for our country.
    Mr. Dunn. Yes, I don't know the answer either. I just 
thought you're so much closer to the delivery than I am, you 
would be able to point me there. And I don't fault you for 
that. I'm curious to know what it looks like, because I've been 
on the other end of that, I'm a physician as well, so I know 
how hard sometimes it can be to live up to the burdens of 
reporting to the Federal Government.
    Is there anything we can do here in Congress to reduce the 
burdens on those providing the vaccinations? Any 
recommendations you have on that?
    Dr. Marsh. I think that, certainly, Congressman, part of 
what we need to do is to continue to work with our Federal 
Government and States to make sure that we build the 
capabilities for appropriate logistics and supply chain 
management. This is such a complicated sort of issue, and each 
State needs to keep track, in my opinion, of their own vaccines 
and their own reporting, but we need to have a coordinating 
function that is very much professional as we are going 
forward.
    Mr. Dunn. Well, I'd like to associate myself with those 
comments. Very good, sir.
    So your independent pharmacies really leaned in and helped 
you a lot. West Virginia has a mostly rural population. I have 
a rural part of Florida is my--where I represent, and I think 
it actually mirrors West Virginia in a lot of ways in terms of 
its rural nature.
    Do you think that the system you set up can work well in 
other areas, perhaps like my district?
    Dr. Marsh. Thank you for the question.
    Certainly I think that each State can come up with their 
own strategies. But I do believe that the idea about setting 
clear expectations and priorities, making sure you have open 
communication and working as a single team, and making this a 
learning mode, not something where it's top down, but you're 
inviting the creativity of your team.
    Mr. Dunn. I appreciate that very much.
    Do you think that there are some specific successful 
strategies for reducing vaccine waste? And I don't know how 
much--as we've said, some of this isn't waste. It's just second 
doses being held, appropriately or inappropriately. But how do 
we reduce waste if, indeed, waste is as bad as we think?
    Dr. Marsh. Thank you, Congressman.
    I know we're over time, and I would just say I think there 
are some strategies we could pursue together to be able to 
accomplish that goal.
    Mr. Dunn. Thank you very much.
    Madam Chair, I yield back.
    Ms. DeGette. Thank you.
    Dr. Marsh, we'd love to hear your ideas for how to improve, 
if you'd like to submit them to our committee.
    The Chair now recognizes the gentleman from California, Mr. 
Ruiz, for 5 minutes.
    Mr. Ruiz. Thank you, Madam Chair.
    Health disparities are symptoms of a failed healthcare 
system, and this pandemic has highlighted those inequities and 
failures.
    We see disparities with Latinos, African Americans, Native 
Americans, high-risk essential workers having a 
disproportionate burden of infections, hospitalizations, and 
deaths from COVID-19. And we are seeing disparities in who has 
access to care.
    We saw it with access to testing. I have been sounding the 
alarm on this issue for months, long before a vaccine was 
available for use. I warned that, without aggressive 
intervention and strategic planning, we would see the same 
disparities play out with access to vaccines.
    And now we are seeing the inoculation process unfold 
exactly as I feared it would, where the highest-risk 
individuals do not have proper access to the vaccines, even if 
they qualify. A good public health approach prioritizes groups 
according to risk of contracting and dying from COVID-19.
    Last year, multiple efforts focused on how to determine a 
fair and equitable way to prioritize who should have initial 
access to COVID-19 vaccines. This planning was crucial. We know 
the disease affects some communities at higher rates and with 
more severe consequences than others: Black and Latino 
communities, high-risk essential workers, such as farm workers, 
the elderly, and people with underlying medical conditions.
    Yet, despite those efforts to prioritize the highest-risk 
groups, there are stark disparities among who has been 
vaccinated so far. A Kaiser Family Foundation analysis found 
that, among the 17 States reporting race and ethnicity 
vaccination data, the share of vaccinations among Black and 
Hispanic people is significantly less than these communities' 
respective share of COVID-19 cases in their States.
    And, despite having disproportionate more infections and 
deaths compared to their White counterparts, they are 
disproportionately vaccinated less than their White 
counterparts.
    In Mississippi, Black people account for 15 percent of 
vaccinations despite having 45 percent of deaths. In Nebraska, 
Hispanics account for only 4 percent of vaccination even though 
they represent 25 percent of cases.
    Furthermore, prioritizing high-risk groups on paper is not 
effective if those individuals are not able to actually access 
the vaccine. Underserved, hard-working communities in my 
district lack clinics and providers. Many people in my district 
don't have access to broadband to schedule a vaccine online. 
They don't have hours to spend on the phone trying to get an 
appointment. They don't have transportation to the vaccine 
site. They don't have access to information in a language they 
understand to help them navigate the system.
    I saw those issues firsthand yesterday when I went to a 
collaborative, nonprofit grower, and public health 
collaborative farm worker community vaccination clinic in the 
fields to make sure that the people tasked with protecting our 
food supply chain were getting vaccines. And I know I'm not 
alone. I hear similar stories from communities all across our 
Nation.
    Dr. Ezike, you and Governor Pritzker have committed to 
putting equity at the forefront of Illinois' COVID-19's 
response efforts, crafting the State's plan while keeping in 
mind, quote, ``the very structural inequalities that allowed 
COVID-19 to race through our most vulnerable communities in the 
first place.''
    Dr. Ezike, how has focusing on equity influenced the 
State's decision on vaccine eligibility and ways to reach those 
vulnerable communities?
    Dr. Ezike. Thank you, sir, for that thoughtful question.
    So of course we know that to get past this pandemic and to 
eliminate disparities, that equity lens has to be at the 
forefront. We know that the CDC has put out information that 
Black and Brown communities are three times more likely to die 
than their White counterparts. And so that's why we have had an 
equity focus, and that has looked in--that has been carried out 
by having lots of virtual townhalls, partnering with minority 
communities to have innumerable number of virtual townhalls in 
Spanish as well as English, working with Telemundo and 
Univision, many----
    Mr. Ruiz. Dr. Ezike, I have 10 seconds left.
    I want to ask Dr. Khaldun, who in their State have been 
partnering with Federal Qualified Health Centers, mobile 
clinics, local department, school-based health centers, and 
other community vaccinators. How will you monitor these efforts 
to ensure they actually result in increased vaccinations among 
vulnerable communities? And what can the Federal Government do 
to encourage the exchange of best practices across State lines?
    Dr. Khaldun. Yes. We are really proud of our strategy in 
Michigan, that we have set out a goal publicly of having no 
disparities when it comes to vaccination rates.
    We are working very closely with our partners on the 
ground. They do--they are going to be sharing with us how they 
are vaccinating in areas that have a higher Social 
Vulnerability Index. And we are holding all of our partners 
accountable for how they are not only receiving the vaccine, 
but what they're doing with it as far as addressing these 
disparities.
    Mr. Ruiz. Thank you.
    Ms. DeGette. I thank the gentleman.
    The Chair is now pleased to recognize another new member of 
our committee, Congresswoman Schrier, for 5 minutes.
    Ms. Schrier. Thank you, Madam Chair.
    Well, we've heard repeatedly that the biggest concerns 
across the country are the lack of COVID vaccine and also the 
confusion caused by the Trump administration's lack of guidance 
for States in the early days of their vaccination campaign. And 
I am hopeful that the Biden administration's national COVID-19 
strategy and the steps it's already taken will get this country 
back on course. And, despite all these challenges, public 
health leaders, like our witnesses today, have been able to 
vaccinate tens of millions of Americans, and I want to thank 
you.
    Now, Kittitas County in my district has proven to be a 
great model for rural communities, much like in West Virginia, 
Dr. Marsh. They have administered 98 percent of their vaccine 
doses, have not wasted a drop, and they have a solid second 
dose set of appointments already booked.
    But here is the thing. Kittitas County is successful 
because Dr. Larson, their public health official, designed a 
nimble distribution system from the ground up, keeping specific 
community needs in mind. And I asked Dr. Larson whether he got 
any specific guidance from the Federal Government in setting up 
this vaccination program, and he said he had not. That 57-page 
document didn't have the specifics that he would have 
appreciated.
    Now, in my pediatrics practice, we, over time, designed a 
fine-tuned system for immunization so there would be no wait 
times. But this is the largest vaccination program the world's 
ever seen, and we shouldn't be asking each city, county, State 
to dream up their own plans and manage their own supply chains. 
It was a disaster when States were bidding against each other 
for PPE at the start of the pandemic, and we still have these 
supply chain issues.
    Now, I personally have had the opportunity to experience 
two community vaccination sites. Both got the CDC manual. One 
ran like a finely tuned machine. The other was limping along 
terribly. And this is a place where I feel like every community 
should have access to best practices, and those can evolve over 
time. The Federal Government could facilitate that.
    Now, because of our experience and the sheer scale of this 
operation, Dr. Larson is now concerned about the supply chain. 
He is concerned that we won't have enough of the low dead space 
needles that squeeze that sixth dose out of a Pfizer vial and 
an eleventh dose out of a Moderna vial. And this is not a 
trivial problem.
    And so the question is for Director Ryan. Given that the 
vaccine supply will hopefully be increasing in the upcoming 
months, there's more approved, and the whole world needs the 
same supplies, which supplies are you most concerned about? 
And, in your opinion, how can Congress help stabilize the 
supply chain?
    Ms. Ryan. Thank you for the question. And it's a good point 
about the specialized needles, because we absolutely are 
counting those sixth and eleventh doses in our planning.
    You know, I would say we worry about the supply chain in 
general, not just vaccines, but all the equipment that goes 
along with it. And it's probably, you know, from the beginning 
of the pandemic when we were absolutely choked by the lack of 
PPE and testing.
    And so I think, you know, a great role of the Federal 
Government is just ensuring that those supply chains don't 
seize up, as everybody around the world needs the same 
supplies, that, you know, we are doing additional manufacturing 
where we can, because it's one thing to have the doses and 
then, to your point, if you don't have all of the other 
supplies that go with it, then it just absolutely slows down or 
hampers your response.
    Ms. Schrier. Thank you.
    And, Dr. Marsh, the country has marveled at how well your 
State has rolled out its vaccination program. Are you also 
concerned about the availability of PPE and needles and, you 
know, testing equipment and the like, and what would you 
suggest for Federal support?
    Dr. Marsh. Well, thank you, Congresswoman. I think that's a 
particularly important point to make. Certainly in West 
Virginia, we have tried to become more self-sufficient, but we 
are actually making our own PPE. We've designed our own N95 
equipment masks, our own PCR testing, our own antibody testing. 
We're working on doing molecular virology testing for the 
mutant viruses.
    But I think that, as you point out, as the governments of 
South Korea and others learned through their SARS/MRSA 
experience, the more self-sufficient we get as a country, the 
more we start to make our own stuff so we don't have to rely on 
other supply chains, the better off we'll be throughout not 
only this pandemic but I believe in the future.
    Ms. Schrier. Thank you. I completely agree. Yes, to 
vaccinate 300 million Americans by the end of the summer, the 
availability of all supplies is going to need to keep up with 
the supply vaccine. That means we have to be manufacturing 
here. I am just so grateful that this administration's already 
taking actions to make sure that our supply chains are solid.
    Thank you. I yield back.
    Ms. DeGette. The gentlelady yields back.
    The Chair now recognizes the gentleman from Pennsylvania, 
Mr. Joyce, for 5 minutes.
    Mr. Joyce. Good afternoon. Good afternoon. I'd like to 
thank Madam Chair DeGette, Ranking Member Griffith, as well as 
Chair Pallone and Ranking Member McMorris Rodgers and the 
witnesses for appearing here today. Truly, it's an honor to be 
serving on Energy and Commerce Committee in the 117th, and I 
look forward to continuing this strong bipartisan tradition of 
Energy and Commerce.
    The COVID-19 outbreak and the global spread has created 
public health challenges unlike anything we've ever seen in our 
lifetime and, as a physician, unlike anything I had ever seen. 
President Trump, and along with Congress, worked together in a 
bipartisan manner to pass several relief packages last year to 
respond to the pandemic, including billions of dollars in 
support of a vaccine. This includes nearly $30 billion that was 
passed at the very end of last year in the Consolidated 
Appropriations Act.
    Last year, the partnership of Operation Warp Speed started 
by President Trump produced multiple safe and effective 
vaccines in record time, and millions of doses were shipped 
across our country. These vaccines are the silver bullet out of 
this pandemic, and we must act now to ensure their quick 
distribution.
    This is why it is so disturbing to me that in my home State 
of Pennsylvania we remain behind the national average for doses 
administered, in a lowly 37th in doses administered as a 
percentage of population. Furthermore, I hear from my 
constituents every day who are eligible to receive the vaccine, 
but they simply cannot find a dose.
    Dr. Marsh, thank you for appearing today. As a doctor 
myself, I am concerned about Pennsylvania's vaccine rate of 
less than one-half of what you've achieved in West Virginia. 
West Virginia's success story should be applauded and needs to 
be replicated across our country.
    Could you please elaborate--and I know that you've been 
asked this previously but ran out of time. Could you please 
share what are committee's efforts that need to be made to 
ensure that the vaccine deployment occurs, especially like in 
rural communities where I represent?
    Dr. Marsh. Thank you, Congressman. I will try to be brief. 
I do think that there's three parts to your question that are 
really, really important.
    So, number one, I think that everybody needs to get on the 
same page and be committed to a single team's efforts. Just 
really briefly, CDC's data from August says that in comparison 
to 18-to-29-year-olds who get COVID, that if you're 50 to 65, 
your risk of death is 30 times higher, risk of hospitalization 
4 times higher. If you're 65 to 75, risk of death 90, 9-0, 
times higher, risk of hospitalization 5 times higher; 75 to 85, 
risk of death 220 times higher, risk of hospitalization 8 times 
higher. Over 85, your risk of death is 630 times higher, risk 
of hospitalization 13 times higher.
    Once you understand what your purpose is, once everybody 
throws together on the team and sacrifices to make sure you can 
push doses to the most vulnerable parts of your population, 
what saves lives, reduces hospitalizations, then things start 
to work well. So I think open communication, you know, 
everybody on the same page, clear and where we're going.
    And then I think that having the logistics expertise is so 
important. We've turned to our National Guard because they're 
our experts, but I think federally starting to think about 
supply chain and logistics will be very important.
    Mr. Joyce. Dr. Marsh, continuing on that all-hands-on-deck 
attitude that you've brought forth in West Virginia, are there 
additional Good Samaritan safeguards for qualified volunteers 
that could help augment the administration of the vaccine?
    Dr. Marsh. Absolutely. We're vaccinating our students as 
well, who are becoming part of our vaccination team. We've 
called it ``vaccinate the vaccinators,'' because we want to 
continue to expand our infrastructure so, when additional 
vaccine comes available, we'll be able to turn that very 
quickly and expand our capacity to vaccinate more West 
Virginians.
    Mr. Joyce. And I'd like to conclude by asking each of the 
panel today, do you feel that additional vaccine and their 
administration is the light at the end of the tunnel?
    Dr. Marsh, I'll ask you to answer first.
    Dr. Marsh. Yes.
    Mr. Joyce. Dr. Phillips.
    Dr. Phillips. Yes.
    Mr. Joyce. Dr. Khaldun.
    Dr. Khaldun. Yes.
    Mr. Joyce. And, Director Ryan, do you agree that the light 
at the end of the tunnel is being implemented by the 
administration of the vaccine that was developed during 
Operation Warp Speed?
    Ms. Ryan. Absolutely.
    Mr. Joyce. Thank you all for participating.
    Chair--Madam Chair--I yield back.
    Ms. DeGette. Thank you.
    The Chair now recognizes another new member of the 
committee, Congresswoman Trahan, for 5 minutes.
    Mrs. Trahan. Thank you, Madam Chair.
    And it's wonderful to hear from all of you to make 
contagious the successful programs that you've led in your 
respective States.
    I fully share the sentiment that we all need to be on the 
same page, on the same team, when it comes to battling COVID. 
And, as we celebrate the miracle of having two highly effective 
vaccines, we must be focused on dramatically accelerating 
distribution while also addressing the fact that we've fallen 
behind on developing treatment and therapies. We've fallen 
behind on innovating and creating capacity and testing, which 
is integral to our opening of schools and businesses. And we've 
fallen behind on investment in genomics research, specifically 
sequencing surveillance that identifies new variants, ceding 
our leadership to other countries.
    I suspect that all of us would agree that, as we accelerate 
vaccination, it's essential for us to close the gaps in access, 
especially among our communities of color. And I associate 
myself with every syllable that Dr. Ruiz spoke in his remarks 
about equity.
    Additionally, we mustn't allow the well-being of residents 
at long-term care facilities to fall behind. As everyone knows, 
these folks are especially vulnerable to COVID-19. In the State 
of Massachusetts, of the 14,000 COVID-related deaths, nearly 
8,000 have been reported in these facilities. And the 
disproportionate impact of COVID-19 isn't limited to the 
residents of these facilities. A considerable share of our 
long-term care services workforce is composed of immigrants, 
some of whom have limited English proficiency and lack access 
to internet-only vaccine signup systems.
    So I'd like to use my time to discuss the challenges you're 
facing and the best practices you're using to protect not just 
the residents of long-term care facilities but also the staff.
    Dr. Marsh, as Ranking Member Griffith mentioned, West 
Virginia elected not to participate in the Federal Pharmacy 
Partnership, and yet you completed second-dose vaccinations in 
long-term care facilities in West Virginia last week. Why did 
West Virginia opt out of the Federal program, and how were you 
able to vaccinate your long-term care facility residents so 
quickly? Are the staff also vaccinated as well? And are there 
any lessons that other States and pharmacy partners can take 
from your success?
    Dr. Marsh. Well, thank you for the question, Congresswoman. 
That is a very important one. We know in West Virginia 50 
percent of our deaths are from residents of nursing homes. And 
so, as we went forward, we wanted to understand what was the 
most rapid, expeditious way that we could move vaccine to the 
arms of, as you've mentioned, not only the residents but the 
staff and the support folks there.
    And what we did is we turned--as I said, in our joint 
interagency task force, in our open team-of-teams mode--we 
turned to the leader of the long-term care association and our 
member from the pharmacy board and we asked them what was the 
best way to go, and they came back and told us we have 250 
pharmacies located all over the State, half of which are 
privately owned and that the Federal program would not get us 
to where we want to go as quickly.
    And so we went with this approach: We met with General 
Perna, with Dr. Patel from Operation Warp Speed, we told them 
what we planned to do, they said, ``Good. That sounds great for 
West Virginia.'' And, ultimately, we did not get rid of the 
Federal program, we just didn't activate it.
    When it came to immunizing our residents, 85 percent or 
more agreed to get immunized, but only about 65 percent of the 
staff. And what's really heartwarming is, after we've been 
through this round of vaccines, first and second round, we have 
a lot of staff now that are coming back and saying, ``We want 
to be vaccinated now.'' So that makes me feel really good about 
the future for vaccine hesitancy.
    Mrs. Trahan. That's helpful. Yes, the recent data from the 
Federal Pharmacy Partnership shows that roughly 37 percent of 
staff participating in long-term care facilities, a workforce 
that is disproportionately comprised of people of color, 
decided to get vaccinated.
    And so, Dr. Khaldun, what is the State of Michigan doing to 
address the equity and hesitancy concerns among healthcare 
workers, including staff at nursing homes and other long-term 
care facilities?
    Dr. Khaldun. Yes, absolutely. So we, of course, prioritize 
our most vulnerable residents of our skilled nursing 
facilities, our long-term care facilities, and, of course, the 
staff. We actually had over 4,400 facilities that were 
enrolled, are enrolled in this long-term care program. And so 
we similarly were challenged with the speed of the program. We 
had to take doses out of the allocation, engage additional 
pharmacies as well.
    But we've also been challenged by hesitancy. We actually 
have a robust paid media effort. We're engaging with members of 
the community. We just last week launched our Protect Michigan 
Commission, which includes more than 60 people who are 
distributed across the State that are really going to be the 
messengers that have that information about the safety and 
efficacy on the vaccines.
    So we are using something similar to what we did with our 
Racial Disparities Task Force and how we were able to actually 
essentially eliminate the disparity between African Americans 
and Whites for COVID-19 cases and deaths.
    Mrs. Trahan. Thank you. I appreciate your time. Appreciate 
your efforts.
    I'm out of time. I yield back.
    Ms. DeGette. I thank the gentlelady.
    The Chair now recognizes the gentleman from Alabama, Mr. 
Palmer, for 5 minutes.
    Gary, we can't hear you. It says you're not muted. Try 
again.
    You have headphones on, I think. We still can't hear you. 
I'm going to go--Gary, I'm going to go on to the next person, 
then we'll get you in. OK?
    Great. Thanks.
    I'll now recognize Mr. O'Halleran from Arizona for 5 
minutes.
    Mr. O'Halleran. Thank you, Madam Chair and Ranking Member, 
for having this meeting.
    There's an urgency on the ground into getting vaccine doses 
out. Over the past several weeks, I've heard consistently from 
Arizona public health officials that we need more vaccine.
    You know, back in December, I asked Dr. Fauci and the head 
of the CDC and the logistics head, ``Are we ready, going to be 
ready in the fall? In the winter?'' They said, ``We hope so.''
    In September, I asked Dr. Fauci, ``Are we going to be ready 
soon?''
    ``I hope so.''
    We are still hoping, because of the lack of a coherent 
national plan.
    And, you know, I've heard testimony today about 
transparency, data systems, the public education campaigns, 
none of which are where they need to be at this point in time 
for this vaccine program to work at all.
    As of yesterday, only 65 percent of shots have been used 
nationally. My home State of Arizona lags behind at just 61 
percent. Notably, these numbers have improved in recent weeks 
and are trending upwards.
    I'm trying to understand where the disconnect is here. With 
such a large demand for shots, we need to understand why more 
than one-third of shots distributed nationally have been 
unused. And I believe hesitancy from priority individuals needs 
to be discussed. Just today, it was reported that only 37 
percent of nursing home staff have received their COVID-19 
vaccine, in spite of what was going on in West Virginia.
    But I think that we have--solving the second-shot issue, I 
don't know where we're going to be with that. Six weeks, eight 
weeks, elderly people, nonelderly people, who. Recent 
developments regarding the variants of COVID-19, including 
those from South Africa and the United Kingdom, have emphasized 
the importance of being vaccinated.
    When it comes to these more easily transmitted strains, 
using every available dose as soon as possible will help ensure 
that these variants do not continue to evolve in a way that may 
cause vaccines to become less effective. However, this will 
prove problematic if delays in getting these second shots 
happen. But protection against these variants will be even 
worse if individuals do not get their second shot of the 
vaccine within the recommended time or soon afterwards. We have 
cases of the second shots being delayed up to 6 weeks already. 
I hope that this does not continue.
    Many rural communities, which have been talked about, 
Tribal communities and communities of color, often have been 
hit the hardest by COVID. Tribal communities like Navajo, White 
Mountain Apache Tribe, and others in my district have had some 
of the highest rates within the United States. Likewise, our 
healthcare resources in rural and underserved communities have 
been stretched thin, to say the least.
    To overcome systematic and long-term standing trust issues, 
the roots of which we have seen--yet to see again during this 
pandemic, we must work with these communities in an educational 
process, as well as a professional, medical process.
    Dr. Ezike, you have touched a bit on resources needed to 
promote confidence in the COVID-19 vaccines. What resources can 
the Federal Government provide to help States in overcoming the 
hesitancy with COVID-19 vaccines? What would you like to see in 
a national public education campaign?
    Dr. Ezike. Thank you, sir, for the points raised and that 
important question.
    So these things, as you said, predate COVID but have been 
highlighted by COVID. And so one of the things that is pretty 
fundamental is in the area of health promotion and health 
education, making sure that even from very young ages we talk 
about the importance of vaccines, explain vaccinology, the 
science of vaccines, relate even to youngsters how they don't 
know about measles, even chicken pox now, polio. No children 
are doing double Dutch with braces on their legs, because polio 
and so many diseases have been eradicated by vaccines. Many 
people don't understand where we've come from to be able to 
appreciate the vaccines that they have been able to receive or 
not receive in some cases.
    So starting with that, again, that's a long--that's a long 
haul. That's infrastructure building that may not give us the 
full fruits for this vaccine, for this pandemic, but actually 
will help us towards the next.
    Mr. O'Halleran. Thank you, Doctor. My time is up. I'm 
sorry. I just want to point out we're still hoping, and I hope 
that we are able to get some of the basics done in a short 
time.
    Thank you very much, Chairwoman.
    Ms. DeGette. I thank the gentleman.
    OK. Mr. Palmer, back to you. Let's see if your sound is 
working.
    Mr. Palmer. Can you hear me now, Madam Chairman?
    Ms. DeGette. Yes. You're recognized for 5 minutes.
    Mr. Palmer. Thank you.
    Dr. Marsh, part of your State's success in vaccine 
distribution, as has been pointed out already, is due to the 
decision not to participate in the Federal Pharmacy Partnership 
Program. How did you guys arrive at that decision?
    Dr. Marsh. Well, thank you, Congressman. As I mentioned 
earlier, we tasked our leadership from our long-term care 
association, along with our pharmacy leadership. As I 
mentioned, we had made the initial decision to have all of our 
vaccine run through our pharmacists and pharmacies because of 
the critical nature of the storage of the Pfizer vaccine as we 
started. And so those two individuals went out and gave us the 
information that having an arrangement network of local 
pharmacies with long-term care facilities that were located 
throughout the rural parts of our State was the best strategy, 
and that's how we came to that decision.
    Mr. Palmer. I want to go back to a point raised by my 
colleague, Mr. Ruiz, about the number of minorities that are 
not getting the vaccination. And some of my own research into 
that area indicates that there is a reluctance on the part of 
minorities to get vaccinated, and it's particularly true among 
Hispanics and Blacks. I think there was a Pew study from last 
fall that showed that only 42 percent of Black Americans were 
willing to get vaccinated, and among Whites and Hispanics, it 
was 61, 63 percent, somewhere in that range.
    And I just wonder what your experience, Dr. Marsh, has been 
in West Virginia in terms of being able to get the vaccination 
to minorities.
    Dr. Marsh. Well, thank you, Congressman. As perhaps people 
on this call recognize, West Virginia is primarily Caucasian, 
95 percent, but we recognize that we have underserved 
communities of color--African American, Hispanic, Latino, even 
Native American Indian--and we have created a task force that 
meets under the Department of Health and Human Resources 
weekly. And we have funded now faith-based community members 
and professionals of color to be able to administer testing and 
vaccination into the communities of color where there is 
perhaps some distrust that exists, from, you know, Tuskegee and 
other experiences, so that we are trying to make sure that we 
are giving folks the comfort and the trust of the providers to 
be able to reduce hesitancy and to enhance the uptick of 
testing and vaccination.
    Mr. Palmer. Well, I grew up in rural northwest Alabama, 
dirt poor, and I remember as a child when they were rolling out 
the polio vaccine and they were taking us to get vaccinated, 
and I was deathly afraid of needles--something that has 
persisted to this day, I'm ashamed to admit.
    But I also want to point out a couple of other reports, 
another group had done a study, and they said that--and NBC 
News reported that, particularly among Blacks, it's a--a high 
percentage are unwilling to get the vaccine, while others said 
they want to wait and see how the rollout, the first wave goes 
before they choose to get vaccinated.
    But my concern is, as my colleague pointed out, a 
disproportionate number of minorities are really suffering from 
this disease. And maybe this is a question for the entire 
panel. What is being done to educate people, first of all, 
about the dangers that they face? It should be very apparent by 
now, and the necessity of going ahead and getting vaccinated. 
And this is true not just of minorities, because when you look 
at among the White population and you consider that only about 
61 or 63 percent are willing to get vaccinated, that's still, I 
think, a shockingly high number of people who are unwilling to 
be vaccinated.
    That's for the entire panel, if anyone wants to take a shot 
at that.
    Go ahead.
    Dr. Khaldun. I can start. Thank you for that important 
question. I can say it's important when we talk about hesitancy 
that we understand that the history in why communities of color 
may be hesitant, it's Tuskegee, but it's also when communities 
of color engage with the health system today and what they 
experience in the lack of diversity in the healthcare system 
and the bias that exists still in the healthcare system.
    I think it's important that we recognize that and we not 
shame people for being hesitant. And so what does that mean? 
That means creating spaces for conversations, using trusted 
community members. We have a large cohort of people, faith-
based community leaders, leaders who are community members who 
are of color who are writing op-eds and leading conversations 
in the community to make sure people have a space to ask their 
questions and get those questions answered.
    Ms. DeGette. The gentleman's time has expired, and I want 
to thank the gentleman and also the witness.
    The Chair now recognizes Ms. Schakowsky from Illinois for 5 
minutes.
    Ms. Schakowsky. Thank you so much, Madam Chairman, and 
thank you so much for holding this hearing.
    You know, there's been a lot of talk about what could be 
done at the Federal level. Well, fortunately, our new 
President, Joe Biden, announced right away a whole package of 
things that the Federal Government could actually do.
    And I just want to say State and local governments are 
having a hard time. Yes, some are doing better than others in 
terms of the COVID pandemic, but the truth of the matter is 
that, in the big COVID relief package, I'm happy to see that 
the President of the United States has understood the plight of 
State and local governments who have lost their revenue because 
of the economy virtually shutting down, who have had trouble 
just making the trains go and helping their healthcare workers 
and their first responders to have enough money.
    All of the costs of the--or most of the costs, anyway--of 
the pandemic have fallen on local governments, not-for-profits. 
And, fortunately, our President has said that the big package, 
the $1.9 trillion, is going to address the needs of State and 
local government. And what have we seen from the Republicans? 
No, a fraction of that, and to take out all the money to help 
State and local governments.
    And so I wanted to ask Dr. Ezike--and thank you. I want to 
thank you, Doctor, for coming today, for the work that you're 
doing to try and help all of the people in the State of 
Illinois and to get vaccine where it needs to go.
    If we were able to get more State and local help, how do 
you think that that would alleviate some of the problems that 
we have been seeing?
    Dr. Ezike. Thank you so much, Congresswoman, and thank you 
for your continued support along this pandemic journey.
    So we know that the expansion of the network will increase 
the reach. That means that more people will be able to access. 
That will give opportunities for, you know, mobile vans to go 
to hard-to-reach populations. That will allow people to focus 
and have a specific POD for seasonal workers or migrant 
workers. So the expansion of efforts, the expansion of the 
network just allows the reach to get more corners, every nook 
and cranny of our State, and to get it quickly, and also apply 
that equity lens so that we're clear and intentional about the 
groups that are often left behind--that have been left behind, 
to intentionally go after them, both with the appropriate 
messaging, the appropriate messenger, and the appropriate 
language, to be able to get those people on board as well.
    Ms. Schakowsky. Thank you.
    You know, I have focused a lot on the elderly since I've 
been in Congress, and it is so important that we're able to get 
the vaccine to older Americans. And I know that in Illinois now 
we're in 1B, that is, that people 65 years old and older. But 
we have seen some difficulties, and I've certainly heard calls 
at my office of people of that age and way more that are having 
a hard time just navigating the system. And I'm just wondering 
what kinds of things that you are doing and that the State is 
doing to make sure that our older population is having access 
to the vaccines.
    Dr. Ezike. Thank you, Congresswoman, for that important 
issue as well. We know that everyone is not able to use the 
internet and to access vaccines doing that way, and so all of 
the local health departments are being encouraged to use 
resources, to expand the phone lines, so that there can be 
people that can call and have that warm hand to help them 
through it. People are creating waiting lists of people who are 
trying to get the vaccine and then reach out personally and 
help schedule that vaccine so they can call back with an actual 
time.
    So we need more people, not just vaccinators, but 
navigators and community organizations, that can help with 
identifying people who have to get the vaccine that can't do it 
through the traditional methods that have been established and 
can be led to the vaccine, and including using the additional 
resource that are needed for even transporting people who want 
to get vaccinated to the site.
    So all of those things are part and parcel for getting our 
most vulnerable populations vaccinated as well.
    Ms. Schakowsky. And all of those things cost money to do, 
and I'm looking forward to some help from the Federal 
Government as well.
    Thank you, and I yield back.
    Ms. DeGette. I thank the gentlelady.
    I believe all the members of the subcommittee have now 
asked questions, and so we will--we want to thank the members 
of the full committee who have joined us for this important 
hearing. And, as per committee practice, we will now call on 
them to ask questions.
    Congresswoman Dingell, I will call on you first. Thank you 
for coming.
    Mrs. Dingell. Thank you, Chairman DeGette. I have Michigan 
in the house--it's important--and Ranking Member Griffith for 
convening this important hearing.
    And, you know, we all [inaudible] are right now into three 
categories. One, which is what I'm going to get more into 
detail, is just a shortage of the supply. We had good news 
today from the Biden administration [inaudible].
    Ms. DeGette. Debbie, we're having some trouble hearing you.
    Mrs. Dingell. Can you hear me?
    Ms. DeGette. Yes, OK. Let's try that.
    Mrs. Dingell. Can you hear me?
    Ms. DeGette. You're freezing. I'll come back to you. I'll 
come back to you.
    Let's go to Mr. Walberg for 5 minutes.
    Mr. Walberg. I thank the Chair for waiving us on. This is 
an important hearing that we have here today. And I thank each 
of the panelists for being here as well, and for the work that 
you are charged with doing in States. It's not an easy time. We 
understand that, whether we have disagreements or not or 
whether this sometimes feels a bit like Groundhog Day as we 
talk about things going wrong.
    Director Marsh, I appreciate so much your testimony of how 
you took control and found creative ways, working with 
pharmacies and getting things done.
    And, Director Ryan, I appreciate your testimony of how well 
the rollout process went in getting the logistics and then the 
ability for the State to do what it needs to do.
    But I think there are other things that come into play as 
well as we look forward to the fact that a million doses per 
day has already been achieved as a result [inaudible]. So that 
goal is not necessary anymore. We need to expand beyond that. 
The fact that we're able to produce the doses before even 
approval has taken place. Just think, if that forethought 
hadn't been put in place to work with public and private sector 
to say, ``We're going to let you produce doses before we give 
you the final approval just in case it might work,'' and thank 
God it did and we are getting those doses out.
    Dr. Khaldun, I have the benefit, I guess, of representing a 
district that has its southern border which borders the 
northern borders of Indiana and Ohio. So I have the opportunity 
to see the difference in the way Michigan has handled it as 
compared to those two States. It gives me a little perspective. 
Allows my wife to take me out to dinner in Ohio on Friday night 
when I couldn't do it in Michigan. It allows me to see what's 
taking place in keeping things closed in our State as opposed 
to what took place in Indiana and Ohio and the impact on our 
economics as a result of that. So those are all good things.
    Let me ask you a question. Just a couple of weeks ago, the 
CDC ranked Michigan in the bottom 10 among all States in 
vaccines administered per 10,000 residents. In early January, 
we were ranked in the bottom five. Weeks after, the State 
received more than 500,000 doses of the Moderna and Pfizer 
vaccine. Only 27 percent of available doses had been 
administered, with the State data showing a substantial lag 
between doses shipped out and those injected. And, according to 
the State's own dashboard, there were more than 500,000 doses 
of vaccine sitting on shelves unused while Governor Whitmer 
repeatedly said the State was ready to administer as many as 
50,000 doses per day.
    Now, in all honesty, it's good to hear. The numbers have 
improved in the last week or so, but State health officials 
have not been able to tell us why Michigan has fared so much 
worse than others, including the bordering States.
    Dr. Khaldun, can you explain to me why Michigan in 
particular lags so far behind other States in getting the 
vaccine out? And was this the reason for the resignation of the 
Michigan Department of Health and Human Services Director 
Gordon?
    Dr. Khaldun. So thank you for that question. I'm very proud 
of the work that we've done in Michigan. We're actually one of 
the top-tier States today when it comes to vaccinating our 
population. I'm quite proud of that.
    I think there are a couple of reasons why in the beginning 
it appeared that Michigan was one of the bottom 10 States. One 
of those things was actually data. There was data that actually 
was not coming into the CDC, and we found more than 30,000 
doses that actually we were not getting credit for. So we 
actually found those, submitted those to the CDC. So we were 
actually doing better than what it appeared.
    We also--and we had more than 4,400 facilities in the 
Federal Long Term Care program. There were no doses sitting on 
shelves in the State of Michigan that were in the Long Term 
Care program. So we, just like other States, were able to take 
out of that allocation, put those shots in arms across the 
State, while adding additional pharmacies to be able to 
vaccinate our individuals in long-term care facilities.
    Mr. Walberg. Now, adding to that specifically, as we're 
looking at rolling out the doses for teachers, we want to open 
our schools and schools that are open. I think of one. I was 
talking with a superintendant yesterday who has opened his 
school for testing as well as administering of the vaccine, and 
yet he's been unable to get his teachers registered to be put 
on the list to get the vaccine. Why is that?
    Dr. Khaldun. So thank you for that. We're actually pleased 
that we were able to move forward with having our childcare 
staff and our teachers to be part of this 1B population right 
now. We think it's incredibly important for our students to be 
back in school. We are actually working very closely with our 
local health departments to be able to vaccinate our teachers 
across the State. And so those superintendents are working 
closely with their local health departments.
    Mr. Walberg. My time has expired. I yield back. Thank you.
    Ms. DeGette. I thank the gentleman.
    I don't--I think we lost Mrs. Dingell. And so--are you 
there, Debbie?
    OK. We're going to go to Mr. Soto for 5 minutes.
    And I will say, for those of you who are new on this 
committee, Mr. Soto frequently waives onto this committee, and 
he waits till the bitter end, and I so appreciate it, because 
your input is very valuable. You're recognized for 5 minutes.
    Mr. Soto. Thank you, Madam Chair.
    First, I want to thank the Biden administration for 
increasing Florida's weekly allocation 16 percent, up from 
266,000 to 307,000 for our weekly allotment. That's key. I want 
to thank our colleagues who supported the COVID-19 relief so 
far. FEMA just awarded $245 million to our State to pay for 100 
percent of vaccine costs for the next 90 days, but we need to 
keep it up. Florida is 25th per capita in vaccinations--and we 
need the help--2 million shots in arms and counting.
    I do want to set the record straight. Pfizer was the first 
vaccine approved. It was approved on December 11th, 2020. It 
was not part of Operation Warp Speed. I'm going to repeat that: 
Pfizer was not part of Operation Warp Speed. So it's really 
important to keep the record corrected.
    The real lesson, I think, is we've had bipartisan support 
for NIH funding for years. And that created the health 
technology for making these new vaccines, like with Pfizer, 
like with Moderna eventually. Really important for us to make 
sure that record's clear.
    And outreach is critical, particularly rural communities, 
many of them rural Anglo communities in my district, as well as 
communities of color. We know the history of distrust. It was 
mentioned briefly, but it's important to discuss.
    The Federal Government last century deliberately infected 
Black men with syphilis in the Tuskegee experiment. It 
sterilized Puerto Rican women during the '30s and '40s. So we 
know that this distrust is there from history, which is all the 
more reason why each of us as Members of Congress need to work 
with the bipartisan effort with the Biden administration to do 
our own outreach.
    Local hospitals in Central Florida, such as AdventHealth, 
Orlando Health, and BayCare, Osceola Regional, have given me a 
list of concerns--hospitals from Central Florida--like 
retaining and recruiting expert nurses, concerns of mental 
health for healthcare workers, patient Medicare admission 
criteria for nursing and ALF patients, and citizens in rural 
areas and communities of color. We see retail sites like Publix 
that are doing their best, but it's not present in every 
community across Florida.
    So we've seen uneven allocations like in east Polk County. 
Local African-American cities have been left behind. In Osceola 
County, a majority Hispanic county has been left behind in 
allocations. So I look forward to working with Biden's equity 
task force.
    I want to first ask Dr. Khaldun. In your testimony, you 
state we cannot simply assume our existing healthcare 
workforce, many of whom have been working nonstop, will have 
enough for this massive undertaking.
    Dr. Khaldun, what does your State need for the Federal 
Government to help address these workforce issues?
    Dr. Khaldun. All right. So one thing I'd say--and thank you 
for that question. One thing I'd say is that I'm incredibly 
grateful for the support of the Michigan National Guard. They 
have been partners throughout this pandemic supporting us with 
testing and now with our vaccination efforts across the State. 
I think we also need to bring in more community vaccinators. We 
need to be using clinical students, and that's what we're 
working on as well, just like Dr. Marsh from West Virginia. So 
those are the types of things that we are working on to be able 
to support our healthcare workforce.
    Mr. Soto. And, Dr. Ezike, we know you've mentioned 
workforce capacity challenges. How are you addressing those 
challenges, and how can Congress help you with these workforce 
issues?
    Dr. Ezike. Thank you. So we are expanding the pool, as my 
esteemed colleagues have mentioned. We've increased the ability 
to vaccinate to EMTs, emergency medical technicians. We're 
working to expand to--you know, we have pharmacists, of course. 
We're looking to put phlebotomists in this as well. Dentists 
can be part of this. So we're trying to use as many 
vaccinators. And we're looking even at our partners in other 
countries that are just doing just-in-time trainings and trying 
to bring even nonhealthcare professionals and see if that is a 
possibility under direct supervision.
    So we do need the ability to expand training programs that 
we might be able to have no limitation on the number of 
vaccinators and then just be waiting for the vaccine.
    Mr. Soto. Thank you.
    We saw President Biden bringing up the National Guard, 
enlisting FEMA, 100 percent reimbursement, 100 vaccination 
sites throughout the Nation.
    Dr. Phillips, will this additional workforce help 
Louisiana's COVID-19 program? And what other resources will you 
all need to make sure your residents are eligible for the 
vaccine?
    Dr. Phillips. I think, as mentioned, the National Guard has 
been a critical partner here in Louisiana from the start to the 
end. As we faced COVID, we also faced several hurricanes this 
past year, and they were lockstep with us as we went about 
those efforts. And the 100 percent funding is going to be 
critical as that continues. They are our logistical arm, our 
planning force, and our operational specs on the ground. And so 
having that has been extremely critical.
    The other thing that's helpful is that 100 percent FEMA 
funding, which will allow us to tap into those community mobile 
strike teams that are able to go into underserved communities 
using our Social Vulnerability Index tool. Those are going to 
be important to have the funding to be able to support the 
needs that we've identified, in addition to volunteers who are 
retired clinical workers. They've already mentioned students 
and faculty of allied health schools. Looking at our first 
responders, including EMT and fire personnel. Making sure we 
have access to all available individuals who are medically 
trained to be able to provide a vaccine.
    And that flexibility. As we learn more, we may have to 
adjust to what we need to do. And having the guidance and the 
funding to be able to support that flexibility is going to be 
critical.
    Mr. Soto. Thank you. My time's expired.
    Ms. DeGette. I thank the gentleman.
    I still don't see Mrs. Dingell.
    So, Mr. Carter, we're going to go to you for 5 minutes.
    Ms. DeGette. Mr. Carter, we can't hear you.
    Mr. Carter. I'm here on the side of the----
    Ms. DeGette. OK. You're frozen.
    Mr. Carter. I'm sorry.
    Ms. DeGette. OK. You want to try?
    No. OK. We've lost Mr. Carter.
    If the panel doesn't mind, we will allow Mr. Carter and 
Mrs. Dingell to submit any questions for the panel that they 
might have by written questions, and we would ask you to submit 
your answers to those questions.
    Is that agreeable to you, Mr. Griffith?
    Mr. Griffith. Yes, it is, Madam Chair.
    Ms. DeGette. OK. In that case, I believe that all of the 
Members have asked questions.
    And I really want to thank all of the witnesses for 
participating in this hearing today. Your testimony and your 
ideas are really helpful and instructive as we try to move 
forward to get the entire population of the United States 
vaccinated.
    I want to remind Members that, pursuant to the committee 
rules, they have 10 business days to submit additional 
questions for the record to be answered by the witnesses who 
have appeared today. And I ask that the witnesses agree to 
respond promptly to any such questions, should you receive any.
    We only had one document request today in this hearing. It 
was the request by Mr. Burgess for the Texas data generated by 
the Data Strategy and Execution Workgroup dated January 31, 
2021.
    And, without objection, that document will be entered into 
the record.
    [The information appears at the conclusion of the hearing.]
    Ms. DeGette. Again, thank you to all of our witnesses and 
Members.
    Mr. Griffith. Madam Chair, if I might correct my one point, 
just so we've got it all down.
    Ms. DeGette. Sure.
    Mr. Griffith. It is true that Pfizer did not receive any 
R&D money as a part of Operation Warp Speed. But, as they 
stated in November, for communication purposes and for 
logistics and obviously because they got a giant contract, they 
did consider themselves a part of Operation Warp Speed, 
although they received no money for R&D.
    Ms. DeGette. All right. Thank you for your comments, Mr. 
Griffith.
    And with that, this subcommittee is adjourned.
    [Whereupon, at 1:48 p.m., the subcommittee was adjourned.]
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